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ftj(^^^^ ^

V / ^

THE JOURNAL

MENTAL SCIENCE

I^ublished by Authority of the Medico-Psychological Association.

SDITED BT

C. L. EOBERTSON, M.D. Cantab.

AMD

HENRY MAUDSLEY, M.D. Lond.

*' No8 vero intellectmn longina It rebos non abstrahinraa qtuun at renun imagiaes et
radii (at in seiuni fit) colre possint'*

FB4MCIB Bacon, ProUg. Inttaurai. Mag,

VOL. xin.

LONDON:

JOHN CHUECHILL AND SONS,

NEW BURLINGTON STREET.

MDCCCLXVIII.

7 • i>'\-^

" In adopting our title of the Journal of Mental Science^ published by anthority
ofthfi Medico-Psychological AuMciation, we profess that we cultivate in our pa^es
mental science of a particular kind, namely, such mental science as appertains
to medical men who are engaged in the treatment of the insane. But it has
been objected that the term mental science is inapplicable, and that the terms,
mental physiology, or mental pathology, or psychology, or psychiatry (a term
much affected by our German brethren), would have been more correct and ap-
propriate ; and that, moreover, we do not deal in mental science, which is pro-
perly the sphere of the aspiring metaphysical intellect. If mental science is
strictly Rynon}Tnou8 with metaphysics, these objections are certainly valid, for
although we do not eschew metaphysical discussion, the aim of this Journal is
certainly bent uj)on more attainable objects than the pursuit of those recondite
inquiries which have occupied the most ambitious intellects from the time of
Plato to the present, with so much labour and so little result. But while we ad-
mit that metaphysics may be called one department of mental science, we main-
tain that mental physiology and mental pathology are also mental science under
a different aspect. While metaphysics may be called speculative mental science,
mental physiology and pathology, with their va?t range of inquiry into insanity,
education, crime, and all things which tend to preserve mental health, or to i)ro-
duce mental disease are not less questions of mental science in its practical, that
is, in its sociological point of view. If it were not ui^ust to high mathematics
to compare it in any way with abstruse metaphysics, it would illustrate our
meaning to say that our practical mental science would fairly bear the same rela-
tion to the mental science of the metaphysicians as applied mathematics bears to
the pure science. In both instances the aim of the pure science is the attainment
of abstract truth ; its utility, however, frequently going no further than to serve
as a gymnasium for the intellect. In both instances the mixed science aims at,
and, to a certain extent, attains immediate practical results of the greatest utility
to the welfare of mankind ; we therefore maintain that our Journal is not in-
aptly called the Journal of Mental Science^ although the science may only at-
tempt to deal with sociological and medical inquiries, relating either to the pre-
eervation of the health of the mind or to the amelioration or cure of its diseases ;
and although not soaring to the height of abstruse metaphysics, we only aim at
such metaphysical knowledge as may be available to our purposes, as the mecha-
nician uses the formularies of mathematics. This is our view of the kind of
mental science which physicians engaged in the grave responsibility of caring
for the mental health of their fellow men, may, in all modesty, pretend to culti-
vate ; and while we cannot doubt that all additions to our certain knowledge in
the speculative department of the science will be great gain, the necessities of
duty and of danger must ever compel us to pursue that knowledge which is to
be obtained in the practical departments of science, with the earnestness of real
workmen. The captain of a ship would be none the worse for being well ac-
quainted with the higher branches of astronomical science, but it is the practical
part of that science as it is applicable to navigation which he is compelled to
study."

J. C. BUCKXILL.

So, LXt — Now Belies, No. as.]

THE JOURNAL
MENTAL SCIENCE

C. L. B0BEBT80M, H.D.Caxuii.
HOEMIT MATJDBLBY. MJ). Lowe.

nAU (ut lu UBM 111} i«ltt inaaiul."

V?vX APBn., 1867.

'^UU.>

LONDON:
JOHN CHURCHILL iND SONS,

NEW BOHUSOTOS OTKBET-
MOOCCUtV)).

Pulvis Jacobi Ver., Newbery's.

FRANCIS NEWBERY AND SONS,

45, St Paul's Clmrcliyard.

This day is published, 8vo, cloth, price 16s.

THE PHYSIOLOGY AND PATHOLOGY OF THE

MIND. By HENRY MAUDSLEY, M.D. Lond., Physician to the West
London Hospital^ Honorary Member of the Medico-Psychological Society of
Society of Paris, formerly Resident-Physician and Superintendent of the Man-
chester Royal Lunatic Hospital.

Pabt L

Physiology of Mind.

Chap.

I. The Method of the Study of
Mind.
IL The Mind and the Nervous Sys-
tem.
IIL The Spinal Cord and Beflex

Action.
IV. The Sensory QangUa and Sen-
sation.
V. The Hemispherical Ganglia and
Ideation.
VI. Emotion.
VII. VoUtion.
VIII. Actuation.
IX. Memory and Imagination.

Paet II.

Pathology of Mind,
Chap.

I. The Causes of Insanity.

II. The Insanity of Early Life.

III. The Varieties of Insanity.

IV. The Pathology of Insanity.
V, The Diagnosis of Insanity.

VJ. The Prognosis of Insanity.

VII. The Treatment of Insanity.
MACMILLAN AND CO., London.

Post 8vo, price 7s. 6d.

LECTURES ON EPILEPTIC, SPASMODIC, NEC-

RALGIC, AND PARALYTIC DISORDERS OF THE NERVOUS SYSTEM,
delivered at the Royal College of Physicians in London. By CHARLES
BLAND RADCLIFFE, M.D., F.R.C.P., Physician to the Westminster Hospital,
and to the National Hospital for the Paralysed and Epileptic, &c.

Subjects :

Lectures I, II, III, and IV. — On certain necessary preliminary Physiological Topics.

Lectures V and VI. — On the Pathology and Therapeutics of Epilepsy, Hysteria.
Chorea, and other forms of Convulsive Disorder.

Lecture VII. — On the Pathology and Therapeutics of the various Disorders in which
Tremor and Spasm are marked Symptoms.

Lecture VIII. — On the Pathology and Therapeutics (1) of Neuralgia, and (2) of cer-
tain Contractions and Sensations which often accompany Paralysis.

JOHN CHURCHILL AND SONS, New Burlington Street.
Second Edition, 8vo, cloth, 15s.

a manual of psychological MEDICINE;

containing the History, Nosology, Description, Statistics, Diagnosis, Pathology,
and Treatment of Insanity. With an Appendix of Cases. By J. C. BUCKNILii,
M.D., F.R.S., and DANIEL H. TUKE, M.D.

" The most comprehensive and practical English work upon insanity now extant.*'
— MedieO'Chirurgieal Review,

JOHN CIIURCIIILL AND SONS, New Burlington Street.

ITo. 6L "Stiw Series, "So. 26.)

THE JOVSNAL OF MENTAL SdEHCE, APEIL, 1867.

[^Published by auihority of the MediethPsyehological Attoeiation,"]

CONTENTS.

PART I. -ORIGINAL ARTICLES.

PA0K
J. Bmce Thomson, L.B.C.S. Edin. — ^The Criminal Lunatics of Scotland . 1

I. B. Belgrave, M.D. Edin. — The Asylums for the Insane in St. Petersburg

and Copenhagen ....... 7

Dr. Edmnnd Hexischler. — A Visit to Gheel. A Letter to the Editors of the
' Journal of Mental Science.' Translated by John Sibbald, M.D.Edin.,
Medical Superintendent of the Argyll District Asylum . . 20

Beoent Contributions to the Pathology of Nervous Diseases . . .44

Hienry Mandaley, M.D. Lond. — Clinical Cases. Acute Mania and Acute

Maniacal Delirium ....... 59

Edgar Sheppard, M.D. — On the Treatment of a certain class of Destructive

Patients . . . . . . * . 65

PART ll.-REVIEWS.

Professor Griesinger's Treatise on Mental Pathology and Therapeutics . 75

Die Pathologie und Therapie der Psychischen Krankheiten fur Aerzte und
Stndirende von Dr. W. Griesinobr, Professor der Medicin und
Director der medicinischen Klinik an der Universitat Zurich, Zweite,
umgearbeitete und sehr vermehrte Auflage. Stuttgart^ 1861, pp. 538 . ib.

Modem Culture: its true aims and requirements. A series of Addresses
and Arguments on the Claims of Scientific Education. Edited by
EnwAan L. Youmans, M.D. Macmillan and Co.« 1867 • • 85

PART lll.-QUARTERLY REPORT ON THE PROGRESS OF PSYCHOLOGICAL

MEDICINE.
t
1. Gemum Psyehohgieal literature. By John Sibbald, M.D. Edin.-^

Zdtschrift fiir Psychiatric, vols, xxi, xxii. — On the Influence of Inter-

nuttent Fever on Insanity. By Dr. Nasse. — The Retention of Memory

in different Forms of Insanity. By Dr. C. Pelmam. — On the Results

of Treatment at Gheel as regards the Cure of Patients. By Dr. F.

WiBDEMSxsTER. — Contribution to our knowledge of Morbid Condi-

ii Contents,

PAGE

lions of the Mind. By Dr. Wills. — On Cold Bathing as a Kemedy
in Mental Disease. — Mental Derangement produced by the Develop-
ment of Echinococci in the Brain. By Dr. J. Knock. — Tabes dor-
salis and Paralysis universalis progressiva. By Dr. Westphal. — On
the Treatment of Melancholia with Opium. By Dr. Tigobs. — An Ih-
strument for determining difference in the size of the Pupils. Dr. F.
Obernier. — On the Development of Grey Cerebral Substance as a
new Formation in the Walls of the Lateral Ventricles. By Dr.
Meschede. — Hereditary Tendency in Insanity. By Dr. W. Jung.
— Typhus among the Insane. By Dr. Wille. — A new System of
Measuring the Head. By Dr. F. Obernier. — A Contribution to
the Subject of diminished Responsibility. By Dr. Flemming. — In-
sanity in connection with Hydrocephalus. By Prof. Albers. — Creta-
ceous Tumours (Sandgeschwulst) in the Insane. By Dr. Ripping. —
Statistics of the Provincial Asylum for Curables and Incurables at
Halle. By Dr. Damerow. — The Prevailing Prejudice against the
Insane. By Professor Jessen . . . . 88 — 113

2. English Psychological Literature, By S. W. D.Williams, M.D., L.R.C.P.L.
— Notes of Lectures on Insanity, delivered at St. George's Hospital,
by Geo. Fielding Blandford, M.B. Oxon. — An Account of a
Second Case in which the Corpus Callosum was defective. By J.
Langdon H. Down, M.D. Lond. — Marriages of Consanguinity in
relation to Degeneration of Race. By J. Langdon H. Down, M.D.
Lond. — Observations on an Ethnic Classification of Idiots. By J.
Langdon H. Down, M.D. Lond. — St. Mary's Hospital. Case of a
peculiar Delirium after Fever ; with Clinical Remarks. By Handfielo
Jones, F.R.S. — Mania after Fever. (Letter from C. Lockhart
Robertson, M.D.)^On Insanity and the Criminal Responsibility of
the Insane. By Thomas More Madden, M.R.I.A., &c. &c. — On

the Two Types of Ancient British Skulls. By John Thurnam, M.D.

114—127

PART IV.-NOTES AND NEWS.

The Lunacy Commissioners and the Surgical Home for Women. — Dr.
Kitching on the Gheel Question. — The Metropolitan Poor Bill. —
The Supervision of Lnnatics in Private Dwellings. — Medico-Psycho-
logical Association. — Publications Received, 1867. — Appointments. —
Obituary ....... 129—140

Notice to Correspondents . . . . . . .140

List of Members of the Medico-Psychological Association . i

No, 62 {new series No. 26) mil be published on the

1st of July, 1S67.

THE JOURNAL OF MENTAL SCIENCE.

[Published hy Authoritj^ of the Medic(hF9ychological Association,']

No. 61. ^"^^^^^^ APEIL, 1867. Vol. XHI,

PART I.— ORIGINAL ARTICLES.

The Criminal Lunatics of Scotland. By J. Bruce Thomson,
L.E.C.S* Edin., and Eesident Surgeon, Greneral Prison for
Scotland at Perth.

For twenty-one years the criminal lunatics of Scotland have been,
with only one or two exceptions, confined in a branch or separate
building of the General Prison, called the Department for Criminal
Lunatics. This department was opened in October, 184j6, under a
public grant ; and due inquiry having been made throughout the
kingdom, aU prisoners of the criminal lunatic class confined for life
or during Her Majesty^s pleasure were transferred thither in terms
of Act % and 3 Vict., c. 4£, and 7 and 8 Vict, c. 8 1<,

Such a prison asylum was called for to ensure '^ close and safe^'
custody of the most dangerous class of lunatics, and more especially
as the superintendents of lunatic asylums objected to receive criminal
lunatics on account of the security required for their safe custody,
and because objections were taken to the insane being associated
with persons who had been charged with committing violent and
heinous crimes.

In Scotland the term criminal lunatic is applicable to the following
classes, viz. :

1. Prisoners found insane in bar of trial,

2. Prisoners tried and found insane at date of crime.

3. Prisoners who have become insane while undergoing their

sentences in prison.

VOL. xin. ^

2 The Criminal Lunatics of Scotland ; [April,

The first and second classes generally comprehend all who have
committed homicide, or other grave dflfences of a violent kind ; class
three was for many years restricted to prisoners undergoing long sen-
tences in the General prison at Perth; but by Act 25 and 26 Vict.,
c. 54, this last class has been made to comprehend prisoners in local
prisons undergoing short sentences of a few months only, if such
insane prisoners are certified as more fit to be detained in the lunatic
department of the General prison rather than in an ordinary lunatic
asylum. By sect. 22 such prisoners may be removed to the lunatic
department of the General prison; and by sect. 19 of the said Act
it is declared that any convict or other prisoner confined in the
General prison at Perth, if duly certified insane, and that his insanity
is of a kind which renders it advisable that he should be detained
in the lunatic department of the General prison, rather than in any
other lunatic asylum, such a prisoner may be detained under
warrant of Her Majesty's Secretary of State in the said lunatic
department.

Only three prisoners have been detained under this section (19)
after expiry of their sentences, aU very dangerous lunatics: one,
J. McG — or G — , accused and convicted of fire-raising, restless,
mischievous, and dangerous, still in custody ; another, J. W — , who
has been twice convicted of assault with intent to ravish; and a
third, J. W — , a powerful and dangerous man, convicted of assault
by cutting and stabbing, and previous conviction of assault, who
recovered, and was liberated by warrant of Her Majesty's Secretary
of State.

The following table gives the admissions annually to the lunatic
department of the General prison for twenty-one years :

1867.]

hy J. Bruce Thomson.

Table of Admusiam, 1846—1866.

CBIKnrAL LUKATICB.

Yeabs-

Totals.

Males.

Females.

1846 ....

1847

1848

1849

1850 ,

1851 .

1852

1853

1854 .

1855 .

1856 ,

1857 .

1858 .

1859 ,

1860 .

1861 ,

1862 .

1863 .

1864 .

1865 .

1866 .

Total ....

129

184

■1 • •

1 1 n e\

The average admissions, per annum, has been 8*8.

The authorities for admission into the lunatic department for
criminals are : — sentence or order of Court, which applies to No. 1
and 2 classes, the class No. 3 being by authority of the General
Board or Prison Managers under medical certificates, and sometimes
by warrant of Her Majesty's Secretary of State.

The proportions of the different classes of criminal lunatics com-
prehended in the above table of admissions were :

1. Of prisoners found insane in bar of trial . 29

2. Of prisoners tried and found insane at date of

crime . . . .26

3. Of prisoners who became insane in prisons . 129

The Criminal Lunatics of Scotland;

[April,

The greatest number have become insane while undergoing
their sentences in the General prison (these are long-sentenced
prisoners) :

Males, for not less than 9 months.

Females, „ „ 12 „

Convict females from 3 years and upwards to life.

All the female convicts of Scotland undergo nearly all their
sentences throughout in this prison, and belong to the most depraved
and dangerous classes — ^the criminal population hereditarily born and
bred to crime.

Our table of criminal lunatics is remarkable for showing that the
males are twice the number of the females, viz. :

Males
Females

129
55

This disproportion of the sexes is very different from what exists
among the insane of the civil population in the three kingdoms. A
table of admissions to Bethlehem Hospital, extending over thirty-
eight years, gave a large preponderance of females: — Males 3*511,
and females 5'407 ; and the reports of the Lunacy Commissioners
generally show the same, the last report for Scotland giving —

Males .
Females

3005
3463

We do not hazard any conjecture as to the cause of the small
number of female criminal lunatics in Scotland.

Table of Age% of Criminal Lunatics •

Tbarb.

Haues.

FeHAIiBB.

ToTATfl.

10 and under 20
20 „ 30
30 „ 40
40 „ 50
50 „ 60
60 „ 70

24
52
27
15

9 '

72
45
19
12
2

Total ....

129

184

By the above table of ages the maximum liability to criminal
insanity appears to be from 20 to 30.
This coiresponds with Dr. Thudichum's cases, amounting to

1867.]

by J. Bruce Thomson.

5122 : whereas the Hanwell statistics indicate the critical period to
be from thirty to forty years of age. EsquiroPs experience led him
to consider insanity liable to increase progressively after maturity.
The ages given of the Scottish criminal lunatics are as at* the dates
of committal, but it is impossible to say how nearly they express the
date of the first onset of insanity.
The offences charged against these 184 criminal lunatics were —

Theft 87

Murder 36

Assanlt 19

Robbery 8

Stabbing 7

Assault with intent to ravish ... 6

Wilfiil fire-raising 3

Bigamy 3

Breach of trust 3

Concealment of pregnancy 2

Malicious mischief 2

Forgery 2

Falsehood, fraud, &c 2

Uttering base coin 1

Rape 1

Horse-stealing 1

Felony 1

The forms of insanity manifested were —

Mania, chronic 70

homicidal 33

„ acute 12

epileptic 6

puerperal 3

melancholia 2

Mania, hysterical

Dementia

Imbecility

Idiocy

Feigned (?)

1
38

7
4
8

The counties from which these criminal lunatics were sent

1 Aberdeen 7

2 Arcrvle

"^ *** o J **'

3 Ayr

4 Banff

5 Berwick

6 Bute

7 Caithness

8 Clackmannan

9 Dumbarton

10 Dumfries

11 Edinburgh

12 Elffin

13 Fife

14 Forfar

15 Haddinsrton

16 Inverness

17 Kincardine

18 Kinross ,

19 Kirkcudbright

20 Lanark

21 Linlithgow

22 Nairn

23 Orkney

24 Peebli

25 Perth

26 Renfrew

27 Boss and Cromarty

28 Roxburgh

29 Selkirk

30 Stirlmg

31 Sutherland

32 Wigtown

33 Zetland

0
1

40
2
0
0
0

11
6
1
5
1

18
0
3
4

Intending to enter into further particulars of the class of lunatics
at some future time, I cannot "avoid oflFering a few remarks, in con-
clusion, as to " who ought to be considered criminal lunatics under
the charge of the State V^

Objections have been taken in toto to criminals being, when
insane, treated in other than the common lunatic asylums of the
county, and that, properly speaking, there ought to be no such dis-
tinctions as are held betwixt the criminal class and other lunatics.
But in Scotland we have practically found the objection very strong

C) The Oriminal Ltmatics of Scotland. [April,

and general against criminals being admitted to ordinary asylums.
The following is an example of this :

W. C— ; secreted a lethal weapon, and suddenly murdered one of
the inmates in the asylum where he was an inmate. Some delay
or hesitation as to the procedure of the public prosecutor took place,
and the homicidal act seemed to be overlooked, when the asylum
functionaries began to consider that it would be well to get quit of
the criminal lunatic, and refuse to retain him in their charge. Per-
haps they thought it might injure the establishment. Be that as it
may, the public prosecutor, as we believe, for fear of the criminal
lunatic sooner or later being set at large, brought him to trial before
the High Court of Justiciary, Edinburgh. The verdict was, ^' Insane
at the time of the offence/' and he was ordered to be placed in strict
custody during Her Majesty^s pleasure. Here, then, was a case
showing the necessity of an asylum for the safe custody of this
class of lunatics.

Another recent case, where a criminal lunatic was placed in an
ordinary asylum, and afterwards set at large, as it seems, injudiciously,
may be here referred to. The truth is, private friends and petty
interests are less likely to induce those in charge of lunatics to set
them at liberty, if the patients are under the charge of the State.

stabbed a man in the streets, the lunatic being under a

fit of temporary mania from intoxicating liquors. The criminal
lunatic had hereditary tendency to insanity. As in cases of this
kind, the homicide recovered his intellects almost immediately after
the heinous act, and continued well for a time under the quietude
and exemption from all exciting causes in the asylum. At length
he was liberated, and not long after was again incarcerated for an
act of violence. My doctrine is, that such a man's antecedents were
quite sufficient to lead to his detention for life in confinement, and
for this purpose he ought to have been in charge of the State as a
criminal lunatic. This was one of the few criminal lunatics of
Scotland charged with murder, who were allowed to be placed in an
asylum other than the lunatic department of the General prison.

As a general rule, then, all who have committed violent and grave
offences, found insane at the time of offence, or found insane in bar
of trial, ought to be regarded as criminal lunatics, and under the
charge of the State in a prison asylum.

But very different views are held upon what classes come within
the category of criminal lunatics; and in the three kingdoms no
distinct agreement is found as to who are criminal lunatics.

About two years ago I visited all the criminal lunatic asylums in
Great Britain, and was greatly surprised at the differences of
practice on this important matter.

The great criminal asylum at Broadmoor was newly opened in the
beginning of 1864, when I visited it; and there I found, under a

1867.] The Asylums for the Insane in St. Petersburg, ^c, 7

royal or Secretary of Staters warrant, a number of patients who had
committed petty crimes, and were labouring under imbecility or de-
mentia— persons by no means violent or dangerous. Why should
not such cases be placed in pauper asylums rather than in a State
asylum, perhaps for life, under a royal warrant ? I am aware that
there had been a selection made from the criminal lunatics before
Broadmoor was opened, but it did seem that a re-selection was
required.

In Ireland the state of matters, owing partly to the distracted
state of the country, was still more anomalous. By the Acts 2 Vict.,
cap. 27, and 8th and 9th Vict., cap. 107, insane persons, when
duly certified to be dangerous lunatics, were committed to prison.
The results were, disturbance of the prison discipUne and defective
care and treatment of lunatic prisoners. When I visited, in 1864,
the central asylum at Dundrum,the inmates amounted only to 128;
whereas, according to the report of 31st December, 1862, the
number of dangerous lunatics was 378, those not in Dundrum
asylum, being scattered over the various metropolitan and county
prisons, often very ill-cared for. The increased asylum accommoda-
tion, we hope, has remedied this.

In Scotland the term criminal lunatics does not extend to all
criminals insane, but has been carefully restricted to those com-
mitted for violent and grave crimes, and whose hberation would be
dangerous to the lieges. In this respect Scotland is better than
England. The criminal insane of Scotland are not, as in Ireland,
detained in prison cells like common criminals, but placed in the
lunatic department, a branch of the General prison, yet having all
the comforts of an asylum that are compatible with the safe custody
of a class regarded as unfit to be at large.

Ue Asylums for the Insane in St. Petersburg and Copenhagen. By

T. B. Belgrave, M.D. Edin.

The labours of the reformers of lunatic asylums in England have
been beneficially felt in the remotest countries in the world. While
in France, where the humane method of treatment was initiated, and
in certain other continental countries, the amelioration in the con-
dition of the insane has been less conspicuous than could have been
desired or expected in nations which have attained a brilUant de-
velopment in most of the other arts of civihsation, Eussia and the
Scandinavian kingdoms have exhibited an earnest desire to avail
themselves of the advantages of the most enlightened treatment.

8 The AsylufMfor the Insane in St. Peteniur^ [April,

It should be a source of just pride to England that in the treat-
ment of the insane she has become a model to the risings and the
envy of some of the older, nations of the world.

In the north of Europe the " English system ^^ is the prevalent
one; and in the erection of new asylums, well-known buildings in
England have been adopted as models.

In Eussia> the public lunatic asylums are undergoing a thorough
reorganization; a new asylum on an improved English model is to
be built in each government, where the existing structures are in-
susceptiUe of sufficient improvement to meet the enlightened views
of the authorities*

The Imperial Government has appointed a central commission,
composed of medical men, to superintend the new organization, and
has wisely accorded them full discretionary power in determining
the plans and arrangements of the new edifices.

In the mean time great eflForts are being made to render existing
accommodation as efficient as possible; and as certain interests, and
the views of particular administrateurs have a tendency to deprive
these measures of their temporary character, it is desirable they
should be criticised freely, though in perfect good faith.

The severity of the climate in Russia, and the long duration of
the winter, increase immensely the requirements of an asylum, and
the expense of its maintenance.

In St. Petersburg there are four public asylums : the '^ General
Asylum,^' situated about seven versts from the city, on the road to
Peterhoff; the asylum at the "House of Correction of St. Peters-
burg;^' the asylum at the "l^st Military Hospital ;'' and the
asylum at the " Second Military Hospital, ' connected with the
" Medico-Chirurgical Academy/* and under the superintendence of
Dr. Bhnski, the professor of psychology in that institution.

The " General Asylum of St. Petersburg,** in which both public
and private patients are taken, is, in more senses than one,, an im-
posing-looking edifice, and is surrounded by extensive grounds,
originally intended for and laid out as gardens, but which are at
present in such disorder that all trace of their original purpose i»
lost.

The building consists of one front and two lateral detached blocks.
It is said to have been built after an English model, and in many of
its internal arrangements it resembles Bethlehem Hospital. The
corridors are long and spacious, but painfully dark, the only direct
light being derived from a window at each end.

The dormitories and day-rooms are situated on each side of the
galleries, the former containing for the most part two beds; an
arrangement contrary to a received principle in asylum arrange*
ments, viz., that two patients should not sleep alone in the same
room.

1867.] and Copet^agen ; ly Db. T. B. Belgbavx. 9

There are no pictures or basts to relieve the monotonous appear-
ance of the wards ; but the furniture is of a plain though substantial
character. There is a beautiful chapel^ but a remarkably small
proportion of patients appear to attend Divine service. The cushions
in the padded rooms are stuccoed with a material which renders
them so hard^ as to impair very considerably their suitability for
those peculiar and rather rare cases for which they are required.
Though the use of mechanical restraint is not professedly abolished
in this institution^ it appears to be so practically.

Notwithstanding the vast extent of the buildings in consequence
of each sleeping apartment containing but two beds^ the greatest
dif&culty is experienced in providing accommodation for patients ;
and recently some temporary wood houses have been erected to
reheve the main building.

Unlike what obtains in other asylums in St. Petersburg^ the
patients are here clothed in ordinary dress.

The diet in this establishment is of a very superior description,
many of the patients having meat two or three times daily. About
100 male inmates are reported to be habitual workers ; but the state
of the grounds, and the size of the workshops, convey the opinion
that their labour is rendered less available than is desirable, either
for its own sake or for its salutary influence on their bodily and
mental condition.

Though land is tolerably cheap in the neighbourhood, no farm is
attached to the institution ; there are no airing-grounds, in which
daring summer patients might stroll at pleasure ; and the garden is
so situated that only the less troublesome patients can avsul them-
selves of it occasionally, vigilant surveillance on the part of several
attendants being moreover rendered necessary by the absence of
railings, boundary walls, or hedges.

The mechanical appliances in connection with the beds for wet
and dirty cases are numerous and ingenious ; but in this, as in every
Eassian asylum the traveller may visit, it will be found that no steps
whatever are taken with a view to prevention. In Great Britain it
is by no means an uncommon circumstance to find, that in an asylum
dontaining 500 or 600 patients, not more than two or three pairs of
sheets have required changing during the night. This result is
accomplished by advantage being taken of the power of habit, and
its influence over the natural functions. Among some people this
power is very considerable ; with the insane, who are so often the
subjects of a paralysis of volition, it is irresistible.

Many patients in whom the routine of asylum life has cultivated
the habit of walking in a particular direction, sitting in a given
situation, or sleeping in a certain room, have been known to jeopardise
and even sacrifice their lives, when a fire, the falling of a wall, or

10 The Asylums for the Insane in St, Petersburg [April,

other accident, have rendered it necessary for them to break through
their accustomed automatic habits.

Some physiological functions are almost completely under the
sway of habit, and an immense experience in England has now
proved that patients who have lost control over their excretory
functions, may be kept dry and clean by being afiPorded the oppor-
tunity, and encouraged, to relieve themselves at fixed and regular
periods during both night and day.

Though throughout the whole Eussian empire there is not a single
estabhshment for the improvement or care of congenital imbeciles,
no attempt has been made in the St. Petersburg asylum to provide
any of those special means of treatment which in England and else-
where have been attended with so much benefit in such cases.

There is one feature in this institution, in common with other
asylums in Eussia, which is well worthy of imitation in England.
A committee of charifable persons of rank superintends the arrange-
ments for the amusement of patients, and, with a view to prevent
relapses in recovered patients who are friendless, or in pecuniary
distress, undertakes to assist them in procuring employment, and to
re-establish them in Hfe, the attendant expenses being defrayed from
a special fund, the produce of voluntary contributions.

These benevolent labours have in practice been found to work
admirably, and the Eussian physicians attribute to this co-operation
an immense influence in promoting the cure of the resident, and
perpetuating the recovery of the discharged, patients. In England,
the physicians to asylums find great difiiculty in organizing sufficient
and regular amusement for patients; and but too often have to
lament the recurrence of insanity in patients who, had they received
a Httle kind guidance and support during a short period following
their discharge, would have retained their restored reason, and con-
tinued useful members of society.

It must be confessed that the structural arrangements of the
principal asylum of St. Petersburg render it ill suited for the
treatment of the insane, however secure it may be as a place of de-
tention. Under the management of an expert experienced in the
details of asylum architecture, it is susceptible of adaptation to what
should be considered the most important object of the institution,
viz., the cure of its afflicted inmates, while at the same time accom-
modation for an increased number of patients might be secured.
The alterations most urgently required are, that the partition walls
of many of the two-bedded sleeping apartments should be pulled
down, associated dormitories to contain ten or twelve beds being
substituted in their stead; that airing-grounds, in which during
summer patients might walk about at pleasure, should be laid out,
and surrounded by ornamental railings ; also, which is of great con-
sequence in the treatment of the insane in a country like Eussia, that

1867.] and Copenhagen ; by Dk. T. B. Belobave. 11

abundance of sunlight and opportunities for exercise should be pro-
vided during the long winter, by the erection of some spacious glass
houses.

Under present arrangements, many of the unhappy inmates might
with equal prospect of benefit be immured in a dungeon, for all the
light they receive during the winter. The attendants in this asylum
are selected from a public institution in which they have been edu-
catedj and are characterised by some degree of refinement, and are
animated by an esprit de corps which is quite unique in the asylums
of Europe, and immensely facilitates the labours of the physicians.
Ladies of station superintend the nursing in the female wards, the *
beneficent influence of whose labours is brought into more striiing
rehef by the difficulties which the professional visitor perceives the
defective structural arrangements must entail on the management of
the house.

Notwithstanding all disadvantages, and in consequence, probably,

of the easy abandon and natural amiability of the Russian character,

the patients in this asylum appear more cheerful and happy than

their brethren in misfortune in most asylums in England. This

gratifying state of things is, doubtless, powerfully contributed to by

the genial personal qualities of Dr. Laurentz, the director, whose

sjstem of government is of the paternal order, and whose kind

sympathy and concern for his patients is reciprocated by an affection

on their part which intense affliction in many cases only stimulates

into more evident expression. There is a sprinkling of patients of

superior station and education in this asylum.

There are three medical attaches ; the superintendent receiving a
lower, and the junior officers, a higher salary than obtains in
England ; the latter also not being on duty the entire week. • It
appears suicidal melancholia occurs less frequently in Bussia than in
other parts of Europe; mania, dementia, and general paresis being
the more common forms of insanity observed in that country.

The excessive consumption of wotky, induced by its unprece-
dented cheapness, has, in the opinion of the medical profession, con-
tributed most powerfully to the increase in the number of cases of
general paresis observed during the present reign. There can be no
doubt that an increased duty on the native brandy is urgently
called for by considerations of pubHc health and morality, as well
as by the increasing financial necessities of the Imperial Govern-
ment.

The asylum at the House of Correction* of St. Petersburg is for
the reception of criminal lunatics. Unfortunately, the institution at
present contains an unusual number of patients of Pohsh nationality ;
the recent political troubles in Poland having, as is so often ob-
served, developed tendencies among many which, during happier

12 The Asylums for the Insane in St. Petersburg [April,

periods might have remained latent, or have exhibited themselves in
less dangerous forms.

It is consolatory to know that the Eussian Government, in its
behaviour towards these afflicted persons, is practically oblivious of
their previous career, treating them with the utmost consideration
and kindness.

The asylum is situated on a floor of a vast prison^ and contains
nearly 300 patients.

It consists of a series of corridors, with bflateral chambers.

Though the galleries are spacious, they are dark, receiving direct
• light through but one window situated at each end.

Some borrowed light is aflForded through a few side windows.

The lateral chambers consist erf handsome dining- and sitting-
rooms, associated and single dormitories.

The furniture is substantial and in good taste, nearly equal to
what is found in Bussian houses of good class.

Graceful exotic plants are placed in convenient situations in both
the rooms and galleries, imparting an air of elegance to the apart-
ments, and contributing to the purity of the atmosphere.

The associated dormitories are lofty, spacious, and well- ventilated,
containing each about ten beds.

The bed-linen is of a very superior description, and the padded
and other single rooms are well appointed.

The asylum contains a painfully large proportion of severe cases
of melancholia and mania.

Mechanical restraint is highly disapproved of by the superin-
tendent. Dr. DinkoflF, and his coadjutor, two PoUsh physicians of
unusual accomplishments, and is only resorted to under very rare
and exceptional circumstances.

An Enghsh lady is resident in the establishment.

There are no airing-grounds or gardens.

Fortunately the present asylum is not destined to be permanent,
but is only intended to be devoted to the detention of criminal
lunatics until a more suitable edifice in the country has been
erected.

It soon becomes evident to the visitor that the majority of the
patients in this estabUshment originally belonged to a station in
society above those classes who recruit most criminal asylums^
Notwithstanding the gloom and unsuitability of the building for the
purposes of a lunatic hospital, and the consciousness of many of the
inmates of the nature of feheir position, the institution is conducted with
singular success. A degree of mirth and contented resignation per-
vades so many of the patients that the visitor with difficulty realises
the fact of its being a prison. This fortunate result arises from the
circumstance that the asylum is exclusively under medical manage^
ment and control, and that the resident physicians are men experi-

1867.] and Copenhagen ; by Dr. T. B. Belgeavb. 18

enced in the treatment of lunacy, and are animated by that spirit of
sympathy for their suffering fellow-creatures which is the charac-
teristic of generous minds.

The in-door recreations in this asylum are more numerous and
more systematically carried out than in many reputed asylums in
England.

The cubical and superficial areas per patient are in excess of
what is considered necessary in England.

The number of cases, and the severity of some, render it of great
consequence that out-door exercise should be afforded to a few even
in winter. A walk or a drive beyond the precincts of the prison
might certainly with perfect safety be afforded to such feeble crea-
tures as many of the inmates appear to be, and would undoubtedly
be attended by most salutary results.

As many of the patients are educated people, a suitably and
liberally selected library should be provided them; and the walls of
the galleries and rooms require to oe freely adorned with pictures ;
not for the sake of additional decoration, but with a view to their
value as means of diverting the attention of patients.

As the aflOiictions of many of the inmates, particularly those of
PoUsh origin, was induced by irregular habits, the natural result of
want of occupation, no convalescent or recovered patient should be
discharged until she or he have been taught some useful art. It
has long been notorious that the perpetual strife in Poland, so pro-
lific a cause of insanity, has been in very great measure caused by
the indolence and ignorance of the useful arts, of the petty nobles,
who, being too proud or too idle to learn a trade, are unceasingly
plotting against a beneficent government, in the hope of ultimately
acquiring what they deem the necessary support of their titular
rank, viz., the possession of serfs. Taking into consideration that
the present asylum is but an expedient, it reflects great credit on its
resident physicians for the skill displayed in adapting a most unpro-
mising building to a very difficult purpose.

The asylum attached to the '^ First Military Hospital^' contrasts
mifavorably with the other departments of the institution.

The wards devoted to lunatic officers here are simply disgusting,
being dark, utterly devoid of pictures, ornaments, plants, or even
decent-looking furniture. The sleeping and sitting-rooms are used
indifferently during the day, and they all bear a cheerless appear-
ance, sufficiently accounting for the discontent and gloom observable
among the unhappy, inmates, who mope about, partially clad in
sombre-looking grey dressing-gowns, apparently without any other
means of diversion than smoking. Though hardly thirty in number,
they distress the visitor by their very natural clamours and excite-
ment, and painfully impress him with a sense of their forlorn and
pitiable condition.

14 The Asyhimsfor the Insane in St, Petersburg [April,

There is no book or newspaper to divert their thoughts^ or to
relieve the monotony of their existence. The triumphs of Eussian
literature might have had no existence, for all the pleasure or benefit
it confers on them. The inimitable wit and humour of the fabulist
Kreloif, the curious research and graceful diction of the historian
Karamsin, and the beauty and originality of the poet Pouschkine,
may meet with as keen an appreciation in an asylum as out of one,
and afford as much relief to the subject of mental disease as to the
sufferer from bodily disorder.

The first military hospital is surrounded by extensive, though
ill-kept, gardens ; practically, however, they are not for its insane
inmates, who are confined within-doors with a rigour which must
be disastrous in its effects on their mental and bodily health, and
certainly ill accords with the enlightened wishes of the Imperial
Government.

The lunatic soldiers confined here fare better than the officers,
having a spacious gallery to walk about in, whereas the wards pre-
viously described are comparatively small rooms.

Not the slightest attempt has been made to adorn the wards by
pictures or other means, nor are any amusements provided. There

15 absolutely nothing to divert the melancholiac from his distressing
thoughts, or to rouse the dement from his stolidity and mentd
inanition.

As in other asylums in Eussia, the food here is superior in quaKty,
variety, and quantity, to what it is possible to afford public patients
in England, where 1?he necessaries of life are so much dearer.

The visitor leaves the lunatic department of the First Military
Hospital of St. Petersburg with a heavy heart, impressed with a
conviction that its managers have ill prepared themselves for their
vocation, and devoutly praying that that Government in whose
service the poor soldiers, among whom (as has been unhappily the
case in England) is many a Crimean hero, lost what is far dearer
than life — ^their reason — may soon transfer them to quarters more
suitable to their condition and commensurate with the sacrifices
they have made in the pursuit of duty.

The asylum attached to the " Second Military Hospital " is con-
nected with the ^^ Medico-Chirurgical Academy,^^ and has been
designed, or rather adapted, by Dr. Belinski, the Professor of
Psychology in that Institution, with a view to instruct his very
numerous pupils.

Other than miHtary men are received ; and persons of both sexes
may enter as private patients. There are in all about two hundred,
the high reputation of the Professor rendering the Institution the
favorite asylum in the city.

The building is of quadrangular form and rather extensive ; be-
hind it are several large and small gardens.

1867.] and Copenhagen ; by Dr. T. B. Belgbave. 15

It having been instituted by the Government for the special pur-
pose of educating young physicians in the treatment of the insane,
with a view to their subsequent employment as managers of asylums
in course of erection, it is unique in its appointments and structural
arrangements. There are six paid medical officers, the superin-
tendent receiving about £150 a year more than his subordinates.
The attendants are in the proportion of one to four patients.

The building is constructed in numerous apartments for the pur-
pose of affording accommodation to patients belonging to different
ranks of society, and to facilitate clinical study without inconve-
nience to the inmates.

Classification of cases is carried out to a greater degree than ob-
tains elsewhere. All medical students who contemplate adopting
Psycliology as a specialty are required to do duty as ordinary attend-
ants during six months.

All the patients are under constant observation night and day,
this practice being facilitated by the internal plan of the building,
which is that of passages about six feet wide, into which open the
common day-rooms, the dormitories, and the apartments for the
wealthier private patients.

Attendants walk up and down these corridors like sentinels, and
are enabled to see the interior of the rooms without being seen ; this
advantage being gained by keeping the patients^ apartments much
b'ghter than the passage, and placing wire blinds behind the inside
windows of the room, which also furnish light to the passages.

This arrangement also offers opportunities for the deUvery of short
chnical lectures to a small party of quiet students without disturbing
the patients, though with many of the pubUc patients who are de-
mented and unexcitable no particular precautions nor ceremony are
exhibited.

Though so many attendants are on duty here night and day, no
preventive measures have been systematically adopted in wet and
dirty cases, the natural result being that instances of this kind are
common enough every day. Dr. Belinski, however, with that readi-
ness to adopt a good suggestion so characteristic of a well-disposed
mind, intends immediately to remedy this defect in the manner
adopted in well-regulated asylums in England.

Mechanical restraint is professed, but rarely adopted, the bat-
tenned, padded, and strong rooms being found equal to most emer-
gencies.

Now and then it is resorted to in certain destructive cases, but
Dr. Belinski entertains the hope of soon being able to dispense with
it in these instances, the difficulty at present being the excessive
cost of sufficiently strong clothing material, which is imported from
England.

In the treatment of certain forms of lunacy, and its general

16 The Asylums for the Insane in St, Petersburg [April,

hygienic influence on all classes of patients. Dr. Belinski is a believer
in water. Hence, lie has fitted up in this asylum an elaborate system
of baths of various kinds ; and, though water is a dear commodity
in St. Petersburg during winter, he can aflFord each of his two hun-
dred patients a bath of fresh water any day of the week, a necessity
which only the very best asylums in England can supply.

Dr. Belinski has had a miniature crystal palace constructed for
winter promenade and recreation ; it is well ventilated and adorned
with a superb fountain in the centre and numerous exotic plants,
which impart to it an aspect at once refreshing and elegant. Among
a people so partial to social intercourse and fond of amusement
abundant means of recreation are indispensable in the treatment of
the insane. Dr. Belinski recognises this necessity, and has met it
in a more complete manner than has been accompl^hed in England.
In addition to billiard-rooms, well stored reading-rooms, and a variety
of gymnastic apparatus, balls, parties, and entertainments of various
kinds are given throughout the year, on a scale and with a degree
of regularity their incalculable importance as curative agencies calls
for. At these reunions, always conducted with becoming decorum
and ceremony, benevolent persons of rank frequently take part.
Attempts are made to draw out particular patients, and all are
gently encouraged to contribute to the common amusement by a
display of their individual gifts.

The history of the asylum, though short, has satisfactorily proved
the compatibility of clinical instruction with successful domestic
management and medical treatment. It has been observed that the
majority of the public patients soon become accustomed to the few
students who accompany the medical oflBcers on their professional
visits, when the young gentlemen comport themselves with ordinary
discretion ; indeed, many of the unhappy creatures appear to derive
benefit from the intercourse.

Instruction is ajBEbrded on a definite plan. Each physician delivers,
in a leisurely manner, short clinical remarks to his small class, in
illustration of the lectures previously delivered by the Professor. A
knowledge of diagnosis, prognosis, and the details of treatment, is
imparted at the same time. Each student has one or two typical
cases allotted to him, which he is required to observe and study
minutely, taking extensive notes of their progress, recording all
evident changes in their bodily and mental condition, the results of
a quantitative and qualitative analysis of their urine, &c.

After having attended the University course of lectures on Psy-
chology, and passed through the clinical ordeal, including the six
months^ residence as an attendant, a student is considered eligible
for the position of resident medical officer in a lunatic hospital.

The asvlum for the insane connected with the '^ Second Military
Hospital of St. Petersburg is the most interesting feature in

1867.] and Copenhagen; hy Dr. T, B. Belgeave. 17

that extensive Institution, and reflects equal credit on the Imperial
Government for its liberality and wisdom in according carte blanche
to competent medical authority in all that concerns its structural
arrangements, and domestic and general management ; and on Dr.
Belinski for the masterly manner in which he has acquitted himself
of his onerous task.

The Asylum for the Insane of Copenhagen and the Island of
Zealand is situated at Bistrupp, about fourteen Danish miles from
the capital.

It contains about 500 patients, public and private ; and is under
the management of Dr. Woldemar Steenberg.

Hie main building has a handsome elevation, and in its external
appearance leaves little to be desired. It consists of a central block
and two retreating wings. The interior does not realise the antici-
pations formed on a. view of its handsome exterior and its lovely
gardens.

It appears, that the evident decadence of Danish power of late
years has so afflicted the national sentiment as to induce a general
gloom and melancholy. The traveller may walk through Copen-
hagen without meeting a single smiling countenance.

A conviction pervades the Danish nation that it is doomed to
absorption by Germany; and this feeling has induced a settled
melancholy, which the universal well-being of the people and the
excellence of their Gtovemment only contribute to make more con-
spicuous. In social intercourse the destiny of the nation is con-
stantly discussed and lamented. One result of this painful feeling
is an increase in the proportion of lunatics to the general popula-
tion.

The predominating form of mental disease is melancholia, charac-
terised in the majority of instances by a distressingly strong tendency
to suicide.

The new edifice has been designed with a view to meet this diffi-
culty; but, unhappily, the structural arrangements adopted are
calculated to intensify the depression of patients without affording
the desired increased security; the galleries, though spacious, arc
insufficiently lighted, utterly devoid of pictures or any pleasing
object to delight the eye; the windows are placed at six or
seven feet from the ground, each frame being sufficiently large to
admit the passage of a man^s body. This arrangement imparts to
the galleries an aspect of intense gloom ; and experience has proved
it to be quite inadequate to effect the object it was designed to
accomplish* Melancholiacs, of all patients, require an abundance of
Ught, and the opportunity to witness cheerful and busy scenes,
without being observed. Were the windows in these galleries on a
lower level, and the panes of glass smaller, the wards would be
lighter and more cheerful, and the attention of their inmates would

VOL. XIII. \

18 The Asylums for. the Insane in SL Petersburg [April,

be frequently diverted by views of the surrounding beautiful scenery,
and by witnessing the labours of their less afflicted companions in
the grounds, increased security being at the same time afforded.

It is gratifying to know that Dr. Steenberg, the medical superin-
tendent, whose'labours on behalf of the insane have gained for him
a high reputation in Denmark, recognises the defects in the building,
and that the municipal authorities of Copenhagen are engaged, at
his instance, in remedying some of them.

Among other improvements, pictorial scraps taken from the
illustrated newspapers, and surrounded by a paper frame, are to be
affixed on the walls of the galleries, as is done with such good
effect in many public asylums in England. Mild mechanical restraint
is occasionally resorted to during the day in particularly destructive
cases, but Dr. Steenberg contemplates abolishing it entirely, substi-
tuting for it the use of clothes made of particularly strong textures,
the English locked button, special supervision, and the other mea-
sures well known in Great Britain.

The sea-weed, which in our asylums is found so suitable as a
stuffing for beds intended for inveterately suicidal cases, for whom
other Lsons render it necessary single-Ldded sleeping apartments
should be provided, is not used in Denmark, though it abounds on
the Scandinavian coasts.

The main building does not contain more than half of the entire
number of patients, the remainder being located in the adjoining
castle (?), and in some lone huts surrounding a square yard. The
ancient castle is not ill adapted for its present purpose, though the
sheds would but make indifferent stables, and are so full of patients
that the beds are but a few inches apart.

Amusements are not carried out in this asylum with the regu-
larity and vigour their influence as therapeutic agents, and the sin-
gular preponderance of cases of melancholia, would lead the visitor
to expect. Labour, however, being more in harmony with the
national habits, is resorted to to an extent exceeding what is customary
in nearly all asylums in England and elsewhere, the celebrated in-
stitution of Clifton, near York, excepted.

When the Copenhagen municipahty have carried out some of the
enlightened views of Dr. Steenberg, their asyhmi will bear a favor-
able comparison with the most reputed in Europe.

At present the traveller is spared the hideous scenes of mechanical
restraint so frequently witnessed in the asylums of France and some
parts of Germany ; and plainly perceives that the defects of the
building, which, by the way, was designed by a non-medical person,
are sought to be counterbalanced by every device which the profes-
fiional ingenuity and the keen Christian sympathy of the resident
physicians can supply.

1867.] and Copenhagen; hy Dr.T. B. Belgravb. 19

Our confreres in the northern countries of Europe are for the
most part highly accomplished, and, enjoying a happy immunity
from prejudice, are nearly always ready to adopt a good idea, from
whatever source it may come.

Through the medium of special associations, they are kept au
courawt of the psychological literature of the day.

Becently an attempt was made to organize a psychological con-
gress for the Scandinavian kingdoms, which, unfortunately, failed.
A general wish, however, prevails among the medical superintendents
<hat the forthcoming exhioition in Paris may afford the occasion for
realising the object on a larger scale and in a more complete
maimer.

As di the present juncture so many countries are either re-
organizing old or erecting new asylums, a congress could not fail to
effect good.

The movement on the continent in reference to the treatment of
the insane is in great measure due to the reputation of the public
asylums in Great Britain.

He key of the English system is " non-restraint -" it is the cause

of its success, and the secret of its difficulty and expense. The

principle that mechanical restraint should be completely discarded in

the treatment of lunacy is based on several most important grounds ;

among others, that the restless, violent, or boisterous conduct

observed in many cases, acts as a safety-valve to the disordered

system, and tends to restore the disturbed nervous equilibrium ; that

when patients, in consequence of mechanical restraint, are unable

"to have their fling out,'^ the duration of the nervous excitement is

greatly prolonged, and its effects on the structure of the brain are of

an injurious and more or less permanent character.

Bodily restraint discourages the restoration of the power of self-
control, debases patients in their own estimation, developes the worst
vices of attendants, has an unlimited power of growth, and in practice
is found almost insusceptible, of being restricted within moderate
bounds. In Eussia, where the most earnest desire exists to intro-
duce our method, the severity of the climate offers increased diffi-
culties. There can be little doubt, however, that the vigour and
determination of the Imperial Government will overcome all obstacles,
natural and artificial, and that throughout the vast empire institutions
for the treatment of the insane will in a few years exist, which, for
perfection in arrangement and the skill and humanity of its managing
physicians, will be worthy of the new social career on which she
is entering, and becoming her position among the nations of the
earth*

20 [April,

A risii to GheeL A Letter to the Editors of the Journal of Mental
Science. By Dr. Edmund Neuschle?; translated with remarks
by John Sibbald, M.D. Edin., Medical Superintendent of the
Argyll District Asylum.

Since public attention was directed to the mode of treating the
insane practised at Gheel, much controversy has taken place both in
this country and on the continent as to the value to be attached to
the system. Alienists from all parts of the civilised world have
visited the locality, and have recorded their opinions of its merits.
These opinions have been almost as various as their authors are
numerous, and have contained the most enthusiastic praise and the
most emphatic condemnation. But the discussion seems now to
have reached a point at which a reliable estimate of the chief pecu-
liarities of the system, such as will be concurred in by the majority
of those who have studied the subject, may be formed. A letter con-
veying a very favorable impression of the colony has been addressed
to the editors of this Journal by Dr. Edmund Neuschler, of the Royal
Lunatic Asylum at Zwiefalten in Wurtemberg, of which I present
the following translation. I shall afterwards endeavour to indicate
what appears to me to be the true view of the question.

18th October, 1866.

Gentlemen, — I do not without hesitation comply with your
request that I should communicate to your readers the observations
which I made during my residence of nine days at Gheel, as Dr.
Webster, who some time ago gave to your countrymen a report of
Gheel as copious as it was true,"^ has lately pubUshed the conclusions
arrived at from his second visit,t to which in all their essential points
I am delighted to give my assent in this communication. Allow me
then to touch on some of the facts more lightly than I would other-
wise have done, and to give expression to my opinion on the much-
contested question, how far Gheel may serve as an example to
other places in the treatment of the insane.

The period of my stay in the principal place in Kempenland ex-
tended from the 11th to the 19th September, 1866, so that I should
have been there during part of the festival of St. Dymphna, had not
the celebration this year been much circumscribed owing to the
prevalence of cholera in Belgium. But I had the pleasure on the
very evening of my arrival of being present at a musical entertain-

* * Joarnal of Psychological Medicine,* 1857.
f * Joarnal of Mental Science,* October, 1866.

1867.] A Visit to OheeL 21

ment that took place in a public garden, and which many of the
inhabitants of Gheel attended. Many of the liigher class patients
were also present, but it would have been difficult for a person not
informed of the fact to believe that such an element was among the
company. Their conduct throughout exhibited nothing peculiar;
they were pleased with the music, and took part in the conversation ;
and in this I had an opportunity of observing the great tact with
which the inhabitants of Gheel are able to treat these unfortunates.

The next day I commenced my walks through Gheel. I went
sometimes alone and sometimes in company with Dr. Bulkens, the
medical superintendent of Gheel, who is unwearied in his attention
to the wants of those placed under his charge, and sometimes along
with Dr. Griesinger of Berlin, to whom our science is so much in-
debted. It so happened during one of our first walks that amongst
those we met Dr. Bulkens pointed out a ragged-looking man as an
insane person. I was astonished at his appearance, and learned that
he and many others belong to a class of patients with whom the
superintending authorities appointed by government have nothing to
do. There are some special communes as well as several private
persons who send their insane to Gheel, without placing them under
the charge of the authorities as regards the choice of nourriciersy or
the superintendence of these or of the patients, or in regard to the
dress of the latter or any of their other wants. These not very
numerous cases {pensionnaires librea) are not included in the
statistics of Gheel, and the authorities are of course not responsible
for their unsatisfactory condition. Their existence has, however,
given rise to many mistakes in the accounts furnished by those
observers who were not aware of their condition. It may also be
well to mention here that these authorities have little or no connec-
tion with the religious exercises, which are held once a year in the
building adjoining the church of St. Dymphna for the benefit of
many of the insane, and which are now falling into disuse. The few
patients who still take part in them are almost confined to those who
visit Gheel for a short time, and then leave directly.

The number of the insane under legal supervision amounted at
the time of my visit to between 1000 and 1100. As fully nine
tenths are of the poorer classes, and are supported at the expense of
their respective communes, you will approve of my having paid par-
ticular attention to their condition; and my remarks as to the care
and treatment of the insane as to the remuneration which the
nourriciers receive, and the guarantee which they give against bad
treatment will all have special reference to these. The insane are
boarded in the houses of the inhabitants. The impression which
visitors receive is somewhat peculiar, when they find that imme-
diately on entering one of the houses they are, as is generally the
case, in the principal room, which serves as an abode for all the

2Si A Visit to Gheel; [April,

inmates during the day. It is a commodious apartment. On one
side is usually the fire, and over it in most cases hangs the pot which
is used for preparing the food of the inmates or of the domestic
animals. On the walls are hung the different household utensils,
among which the brightly rubbed plates and di&hes of the mistress of
the house meet the eye. At the fire are seated the old men and
female members of the household, \^ith the children and such of the
insane as are unfit for field labour. The rest of the male inmates are
only rarely met with at a season when, as was the case during my
visit, they are still busy in the fields. I saw very few of the insane
sitting quite idle, and few who were uninterested in my visit or who
took no notice of it. The majority were everywhere busy, and many
were venr anxious to draw the attention of the visitor to themselves
and to show him what they were doing. Scarcely one was shy or
confused. They rather seemed to be delighted with any friendly
word that fell to their share, and with the interest which I took in
their welfare. Many hastened without being asked to conduct me to
their bedroom, which they have particular delight in regarding as
their own. Each patient has^ a chamber entirely for himself, except
in special cases, where supervision is necessary, when it is shared by a
member of the family. Some of the rooms were decorated, showing
the value that is attached to this independence. These bedrooms are
not large, which may also be said of those of the other inmates of the
houses : and they were formerly even smaller than at present. But
Dr. Bdkens has for some time carried on an arrangement according
to which a certain measurement is required as a minimum for the
floor space and height of the rooms, and for the size of the windows.
Only a few exceptions to the rule remain, and these will shortly dis-
appear. Still the required height and floor space are only sufficient
to give room for a bed, trunk, table, and chair. The window is
generaUy single, and is guarded by two iron stanchions, and though
these are here intended to prevent the escape of the patients, they are,
often to be found on other windows for safety at night. If, how-
ever, as is not the case at present, the patients should ever complain
of them, it would be better that they should be done away with, as
other opportunities of escape are abundant. Dr. Bulkens has seldom
reason to explain of a want of cleanliness in these rooms ; the beds
were in good condition and neatly arranged, the floor clean, and the
whole apartment gave the impression of cleanliness and order, which
had already been produced by the day-room. The dress of the
patients was also in good condition. This is due in a great extent
to the arrangement that aU patients supported at the public expense
have thirty francs deducted from the yearly pay of the nourricier to
be applied to his clothing. I often found on my unexpected visits
the whole household engaged at a general meal. This consists of the
produce of the country, and is suitable to the people, generally

1867.] hy Dr. Edmund Nbu&chler. 28

simple^ coarse^ bat clean and nourishing food. Pork^ potatoes and
other vegetables form the most frequent constituents of the prin-
cipal meal j while for the others coffee^ butter and bread, sometimes
made of wheat, but usually of rye, complete the dietary. Every
nourrider has at least one pig, which is killed at the beginning of
winter, and furnishes a supply of fresh meat and bacon for the house ;
many have more, but none are allowed to be without one ; so that
this domestic animal is the second legally appointed nourrider of the
insane. It is to be understood that the board of the artizans, shop-^
keepers, and the richer class who receive opulent boarders, is better
and offers a wider choice to the patients ; and the houses and the
furniture of the rooms are quite suitable to the requirements of city
residents. In conformity with my purpose, however, I confine
myself specially to the consideration of the poor, and I can assure
you that during my visits, which extended to many houses even in
the most remote hamlets of the commune of Gheel — ^particularly that
of Winkelomsheide, I found the above-mentioned fundamental con-
ditions of comfort for the insane always fulfilled in the manner which
has been described.

As by the hearth and at table, so also in the stable, and the field,
and at the most various occupations, the working patient is the com-
panion of his nourrider. At the time of my visit attention was
universally directed to the potato harvest ; and I saw the liveliest
activity out of doors both among sane and insane. This constant
companionship permits the most natural and unconstrained super-
vision of the patient. It does not annoy him, and it is hardly to be
observed, as the nourrider does not stand over him like an idle
spectator or a keeper, but is apparently engrossed in his own work.
Often, indeed, if the patient is trustworthy, he goes alone to the field,
or is accompanied only by a child ; and it has never happened that
the latter has been injured by his companion. Each feels himself
called upon to watch over his comrade and see that no injury befalls
him. I have often met such patients in the streets and neighbour-
hood of Gheel going to work or returning home, or perhaps only
taking a walk for the sake of exercise, though I should have recog-
nised few of them to be insane without a hint from my conductor.
But this amount of freedom indeed is not constantly accorded to all
the insane at Gheel. Amongst more than 1000 patients twenty
were found in restraint, consisting sometimes of a light anklet, and
sometimes, though more rarely, of a strait-jacket. Both these
kinds of restraint, as well as many others now quite exploded, were
. constantly in use before the establishment of the medical superin-
tendence of Gheel. Latterly it has gradually become milder, and
Dr. Bulkens before long hopes to get rid of it altogether.

In order to avoid the repetition of what is already known, I forbear
to enter farther into the details of the life of the insane at Gheel,

24 A Vmi to Gheel; [April,

especially as men whose disinterested and unwearied sympathy with
this mode of treating the insane have given descriptions whose liveli-
ness is unattainable by my pen. But I am desirous of correcting
one error from which I fear harm has arisen. It has been stated by
too zealous enthusiasts that the inhabitants of Gheel, and especially
the nourricierSj are distinguished by such generosity of feeling and
remarkable habits of seK-sacrifice, that this renders them peculiarly
adapted for the care of the insane. I believe it would be little to the
advantage of Gheel to make a pretence which to the sober observer
must show itself to be a. mere pretence. That hearty desire lasting
for years to render service to strangers out of pure love, and with a
renunciation of the full remuneration usual among other people is so
rare that it adorns but few men, and these in exceptional circum-
stances, and can never be the distinguishing characteristic of a whole
community. It is thus in Gheel. I have often observed truly
moving tokens of unselfish sympathy with the patients. I have in
some Uttle cottages found examples of a manner of acting towards
the insane which could only proceed from a noble and kindly heart ;
and I give the greatest credit for all the kindness which the inhabi«>
tants of Gheel daily show to their 1000 patients. But I do not
believe that this is so rarely to be met with in other places ; and I
have seen no reason for the belief that in Gheel or elsewhere any
other motive but that of material gam will induce a whole population
to devote their entire attention to the care of the inssme as a calling.
Certainly here^ as elsewhere, the rule holds that people will only apply
themselves persistently to what is useful when they receive an
adequate reward ; and the insane at Gheel would certainly not be
well treated if the vocation of nourrieier did not produce actual gain.
It is not my intention in any way to call in question the peculiar
qualifications of the inhabitants of Gheel for tins vocation. It may
be easily conceived how their continued intercourse for centuries with
patients requiring their care, and the influence of the visits of the
patients' relatives, have improved their manners and raised them above
the generality of country people. These circumstances must also
have helped to elevate theur minds, strengthening and developing
those faculties which are peculiarly necessary for the care of the
insane. But on the other hand the tempting stimulus of profit easily
acquired must have contributed to produce along with nourriciers
faithful to their trust, others who neglect their duty. I need hardly
refer to the abuses which reigned in Gheel before the establishment
of the government. superintendence, and which continued to exist up
to a very recent time, until they were checked by its interference.
If I thus hesitate to acknowledge in the population of Gheel, as a
whole, any extraordinary qualities of the heart, I am so much the
more inclined to give them credit for their unquestionably peculiar
capacity on the score of intelligence and experience. A long line of

1867.] hy Dr. Edmund Neuschler. 25

generations having had their attention directed, both for their own
profit and for the preservation of household tranquiUitj and order,
to the rendering the maniacal outbreaks and troublesome habits
of the insane innocuous by averting or mitigating them by means
of gentle and intelligent treatment, must have attained to a pro-
ficiency which has bfeen transmitted as a valuable inheritance to the
present generation. Indeed, the first astonishing impression which
awaits the stranger at Gheel is caused by observing that all the same
mhabitants, young and old, and even the least educated, almost with-
out exception, treat the insane with the most delicate intelligence,
and never give occasion to unpleasant feelings. One might fancy,
indeed, that instead of the tacit understanding which actugJly exists,
there were some particular instructions being carried out as to the
avoidance of everything that could remind the insane of the dif-
ference between their condition and that of the sane. But it is also
to be remembered that modern times and examples of excellent
management, such as we have given, must have had this effect, and
that the abuses which formerly existed were due not merely to selfish-
ness and carelessness, but also to want of intelligence. The best
feelings of the nourndera will require to be continually encouraged
if these abuses are to be permanently removed.

But do these good feelings ordinarily exist ? Is that first con-
dition a suflicient reward — actually given in Gheel ? I can answer
both questions in the affirmative. It is true that the board paid for
the poor is only from 65 to 85 centimes daily, from which, besides
the expense of clothing, 12 francs are annually deducted for medical
attendance. What remains to the nourrider seems little when com-
pared with the price of food in Gheel.* But as the nourricier gene-
rally produces more of these articles than he uses, he does not buy at
these prices, but sells. Still he would be badly paid if the labour
of the patient, which on the average is valuable, were not taken into
consideration. Not a few of the insane are as fit for labour as the
sane, and perform it willingly, as they are well treated and not
restrained without cause ; others perform an amount whose value is
merely nominal when compared with what would be done by the
healthy, and only a few remain whose labour is not to be taken into
consideration ; for these, and for those who, on account of dirty
habits and such like, are peculiarly burdensome, the higher board of
86 centimes is allowed. It is evident, therefore, that by a proper
distribution of the insane the medical inspector may so arrange the
results of the different degrees of fitness for labour, that they will be
as much as possible equalised for the nourriciers. Thus it is that
there is always a sufficient number of those who are ready to receive

• At the time of my visit half a kilogramme of wheaten bread cost 10 cen-
times, 'the same quantity of butcher meat on the average 85 centimes, and of
butter 1 franc 30 centimes.

26 A Visit to Gheel ; [Aprii,

patients, and this is the surest evidence that the nourriciers are
adequately remunerated for what the patients require. They value
this income also for a special reason. As they are paid by the
superintending authorities only at considerable intervals, it not only
constitutes a certain income, but the wages of their labour accumu-
late as in a savings bank, and form an amount which they would
otherwise have difficulty in gathering together. At the purchase of
house and field it is found very useful.

Experience has shown clearly enough that good payment alone is
not always accompanied by proportionally good treatment of the
insane. There must also be continual supervision and direction, as
carried on by Dr. Bulkens. With the able assistance of four
divisional medical officers, always fighting perseveringly with what
is bad, and at the same time preserving with discrimination what
is good, a number of useful reforms have for years been carried
on. Foremost among the improvements is the disregard of every
consideration but the good of the patient when selecting the
nourriciers, as other influences had previously been allowed to inter-
fere. The patient has now his nourricier chosen for him with a view
to his age, manners, language, and calling, and the particular kind
of supervision which is desirable, and, according as the nourricier is
in himself, his family and household arrangements the most suitable.
Of the advantages thus obtained, I will only mention one which is a
distinguishing feature of Gheel, namely, the formation of a special
quarter for the Walloon insane, whose French language is not under-
stood by the lower orders of Flemish speaking inhabitants of Gheel.
B^^ the increased intercourse between the Walloon patients who are
thus concentrated and the inhabitants of this quarter which will
take place, these inhabitants, and particularly the children, will learn
French more easily ; and Dr. Bulkens expects that French will soon
become one of the subjects of instruction at school. In addition to
this, the Walloon patients meet easily with one another. As fellow-
countrymen they associate much together, and every Sunday after
Divine service their rendezvous is in the choir of St. Amaud^s Church,
where they converse, and afterwards strengthen their friendships,
while they partake of refreshment in some place of public entertain-
ment. Dr. Bulkens is endeavouring to associate the idiots in
another part of Gheel, and he hopes to be able to establish special
instruction for them, I might mention many other symptoms of
progressive improvement at Gheel which reflect honour on the zeal
of the medical co-operators.

In spite of the great number of the insane, not only is every
divisional doctor acquainted with all under his own charge, but Dr.
Bulkens is also individually acquainted with the whole. The past
and present state of each patient, his habits and requirements, his
dwelling and occupation, are all known to thei medical inspectors, as

1867.] hy Da. Edmund Nbuschlbr. 27

wdl in the remote parts of the commune as in the centre. He can^
at any hour^ enter any house in which a patient is lodged^ and even
the richer inhabitants who receive patients submit to this rule with-
out opposition. The doctor, when he visits the patients in their
dwellu^s and examines their condition, their treatment and their
work, takes occasion by suitable counsel, praise or blame to exercise
a favorable influence on the nourricier. He examines the application
of restraint in the few cases in which it has been applied by Ins
direction. He cheers the indolent patients, and rewards the in-
dustrious with little presents. He speaks to each patient alone,
and they have easy access to him and to the divisional medical officer.
He sees them in the fields and at their household work, and deter-
mines its amount. Still, the danger of overworking the insane
on the part of the nourriciers hardly requires to be considered,
as excessive work is generally disliked by country people of all
iiations.

The medical inspector has extensive powers of reward and punish-
ment— the most powerful lever of aU authority. The diplomas
which from time to time are distributed with great ceremony to
certain nourriciers depend upon his decision. They constitute an
honorable object of ambition, and are placed in a prominent position
in the house. Another kind of reward which is important is, that
those nourriciers who display peculiar inteUigence and consideration
in the treatment of the patients receive more remunerative patients,
and those who have shown themselves remarkably careful of the old
and infirm have others who are more robust given to them, who
make up by their activity for the deficiencies of their predecessors.
If a nourricier, in spite of warning, neglects the cleanliness of his
own dwelling or that of the patient, or the diet, the occupation, the
superintendence, or any other part of the treatment, the inspector
can transfer the patient to another house, or even strike the nourricier
altogether off the roll. This punishment is so effectual that it only
rarely requires to be carried into effect, and, indeed, the fear of it
lends great weight to a simple reprimand. Por every punishment
not only weakens the credit of the delinquent, whose income it
diminishes, but it permanently injures the man's position, especially
if he is punished for improper treatment of a patient. It is evident
from this, and from many other regulations, how intimately the
prosperity or adversity of the inhabitants of Gheel is bound up with
the residence of the insane amongst them. Of every three houses
there is, on the average, one in which a patient is lodged. If two
persons get married and wish to take up house, their first care is
generaUy to have their names put on the list of nourriciers. If they
obtain this token of confidence and this prospect of a regular income,
th^ are at once in possession of good credit, and if they have a
Utue means of their own they can easily obtain the loan of what is

28 A Visit to Gheel; [April,

necessary to buy at a cheap rate a portion of ground in the outlying
districts ; and with industry they can get on in the world. At first
the house is built of slight materials, but gradually these are re-
placed by brick walls, and outhouses are added, and the area of
house, garden, and field increases step by step, so that soon the
sterile parts of Gheel will exist only in the memory. The whole of
the very evident prosperity of Gheel and its continual increase
depends on its provision for the insane. With this there is con-
nected here, as elsewhere, the increase of education among the
people, the cultivation of their manners, and the decrease of super-
stition and prejudice; and this is the surest guarantee that the
efforts to improve the treatment of the insane will be fruitful in
results. The considerable increase in the number of patients who
have been sent to Gheel during the last ten years is an unmis-
takable effect of increasing public confidence.

As an indicative sign of the privileges which Gheel has obtained
by the intervention of the government, we observe the infirmary in
the vicinity of the village. I do not intend to describe it par-
ticularly, as it does not present many peculiarities. It is in all
essential points built from the plans of Guislain, whose arrangements
Dr. Bulkens could modify only very sUghtly. On the whole, it is
very suitably arranged, though presenting imperfections which I
have also observed in other asylums built under Guislain^s directions.
Of these, I consider that the most important are the second corridors,
or corridors of observation, which he liked to place at the window
side of the single rooms. I hope that the repetition of this feature
will be given up in Belgium, as it tends more than anything else to
give an extraordinary appearance to the single rooms, besides having
other disadvantages which I will not dwell upon. It may also be
mentioned that the windows in the day-rooms are all placed at such
a height that those sitting in the rooms cannot obtain a view of
what is outside. This is an irritating restriction upon the inmates,
and gives an unpleasant aspect to the rooms. I have spoken of the
absence of peculiarities in the infirmary, for you would look in vain
for many arrangements which we meet with in modem asylums,
particularly such as are intended for the entertainment or occupation
of the inmates. Extensive gardens for walks and games, billiard
rooms, a large haU for evening entertainments, workshops, stables
and farm buildings, — all these are wanting. Those only who have
overlooked these remarkable features could ever come to regard it as
belonging to the class of closed asylums ; certainly a great mistake.
The infirmary has been erected only in pursuance of the idea which
Gheel has sought for a century to carry out ; to undertake the
treatment of diseases of the mind in a manner exactly similar to
that of diseases of the body. As it is considered that in a town
where five medical men are employed, the medical service can be

1867.] by Dr. Edmund Neuschlbr. £9

satisfactorily performed only when an hospital is provided for the
reception of such patients as require, either for their own good or
that of their neighbours, that they should be kept separate. For
the same reason an hospital for the insane has been established in
Gheel. It is not on account of their disease in itself, but on account
of certain concomitant phenomena that the insane are brought there.
For besides the course of observation in the infirnjary of the newly
arrived patients, which generally lasts only a few weeks until the
patient is either placed in a private house or is sent away from Gheel
as unsuitable, the principal object of the institution is to receive
from the houses of the nourriciera such patients as are unusually
burdensome or dangerous by reason of severe or infectious illness,
or from long-continued or violent mania, or from their refusing to
take food. The infirmary does not, however, contain any permanent
insane population. There are,. therefore, no arrangements for enter-
tainments or for work which indeed are required almost solely for
those whose condition admits of no further important change.
With the exception of a few patients who, at their own request, are
retained in the house to assist the staff of attendants as kitchen-
maid, porter, gardener, or other such offices, on account of tlieir
peculiar fitness for domestic service, no patients are received into the
infirmary except temporarily ; and the house of the nourricier con-
tinues to be the home of every one in Gheel. It only differs from
an ordinary hospital very well arranged, and abundantly provided
with baths and similar appliances, only by having seven single
rooms for each sex ; five of which are called observation rooms, and
two are actual cells, one of which was being fitted up as a padded
room. The whole house is capable of accommodating sixty patients ;
its changing population amounted at the time of my visit to only
fifteen out of more than a thousand insane in Gheel. How,
then, can Gheel be considered as transformed into a closed asylum ?
There is still another purpose which the building serves. It con-
tains the residence of the medical inspector and of the manager, and
the offices of the whole superintending authorities of Gheel, as well
as the store for the clothing of the insane poor. The baths also are
for the use, not only of the patients in the infirmary, but also to
maintain cleanliness among those who are boarded with nourriciers,
and who come to the house on certain days for this purpose.

The infirmary being thus made use of is certainly the most im-
portant improvement that has been eflected since the introduction
of medical superintendence into Gheel. But it would be erroneous
to overlook tne fact that, in spite of this, the fullest activity of the
medical service is to be found in the houses of the nourriciers.
It is there, particularly, that the divisional medical officers at their
regular visits observe every important change in the condition of
the patients, and adopt such treatment as is practicable in the

30 A Visit to Gheel; [April,

private houses ; or if they consider it necessary, order their removal
to the infirmary. Monthly meetings of the five medical officers are
held for the interchange of their experiences, while the four divisional
officers have frequent interviews with the inspector. Post-mortem
examinations have not yet been introduced in the cases of patients
dying at the houses of nonrriciers. This, for the benefit of science,
would be a very desirable innovation. It would seem that, on
account of the detached positions of the houses, the average number
of 250 patients would be too much for each divisional officer,
especially as they have also general medical practice ; for their salaries
alone would be insufficient for them. But this other occupation has
just the effect of sending the doctors among the Ttowrriciers. And
besides, the great majority of the 250 cases are chronic, who, when
not suffering from bodily disease, give little opportunity for medical
treatment. In addition to this, in the supervision of patients and
naurriciers, the divisional officer is efficiently assisted by his ap-
pointed gnarde de section. Thia applies especially to the superin-
tendence of the use of restraint, which never can take place without
being immediately reported to the medical officer of the division.
This is not the place to discuss the propriety of the absolute disuse
of restraint, though I believe that in a small number of cases the
application of mechanical restraint is no greater evil than the means
wluch are used in its stead ; and that the choice between the two
modes of treatment depend essentially on whether complete con-
fidence can be placed in those who carry it out, and whether it will
be sufficiently superintended ; and as I have observed, besides, that
the use of mechanical restraint as well as of seclusion is much cir-
cumscribed at Gheel, T cannot agree with those who from this
restraint deduce objections to Gheel.

There exists from the consideration of this use of the infirmary,
which has, indeed, removed many disadvantages, a great difference
of opinion as to what kind of patients are suitable for Gheel. Some
would admit scarcely any except the quiet and industrious. But
the extensive choice of nourriciers, who are of very various cha-
racters, the often surprising skill which they display in the treat-
ment of the insane, the detached buildings in the commune facilitating
the supervision of particular patients, will justify the exclusion of
very few classes. The reglSment for Gheel of 1851 alludes to this
subject in section 27,* but this direction is so expressed that if it
were strictly carried out, a great number of the patients at present
in Gheel would be excluded. And yet we find, instead of murder,

* " Les ali^n^ k regard desquels il faat employer avec continuity les moyens
de contrainte et de coercition, les ali^n^s suicides, homicides et incendiaires, ceux
dont les Evasions auraient ^t^ frequentes ou dont les affections seraient de nature
a troubler la tranquiUlt^ on ii blesser la d^cence publique, ne peuvent etre reQus
dans la colonie."

1867.] hy Dr. Edmund Neuschlbr. 31

suicide and arson^ the greatest tranquillity in the streets^ nowhere

any disturbance of public order — ^nowhere are the people afraid of

intercourse with the insane, and the number of escapes is remarkably

small considering the great amount of liberty allowed. Therefore^

I beUeve that those only should be excluded who are unfitted for

this kind of treatment by their peculiarly helpless condition, or on

account of something winch they have done and may do again ; but

not on account of something which it is possible they may do.

Among the unsuitable I would regard the infirm and paralytic, for,

being at the board allowed for the poor, unfit for a family, they

woidd be confined for years in the infirmary ; and also those who

kve made a recent serious attempt on the life of another; and all

fliose patients whose deeply depraved moral condition renders them

more unfit for society when insane than they had previously been.

Dr. Bulkens would prefer that the epileptics and idiots also should

all be removed; and if the latter are to remain,*care must at least

be taken to provide in a suitable manner for the cultivation of their

bodily and mental capabilities.

Allow me now to add a few recommendations regarding Gheel.
Above all, an individual directorate of the whole management should
be established and entrusted to the medical inspector. Many ar-
rangements stiU extant fetter his free action in an unsatisfactory
manner. The very underlings of the infirmary have to obey two
masters. But, particularly, the selection of the nourricier for each
patient is not yet, as it ought to be, the unquestioned right of the
medical inspector. Indeed, he has only succeeded by years of un-
ceasing endeavour in his regular conferences at the meetings of the
superintending committee to combat influences which are still actively
opposed to lum. An increase in the salaries of the five medical
officers would also make them less dependent on their private prac-
tice, and be thus beneficial to the insane. In conclusion, it is in
my opinion specially desirable that the number of insane at Gheel
should not be increased. The more this is done the more will the
supervision by one man become difficult ; rules and forms will take
the place of frequent personal influence ; and the peculiar excellence
of Gheel, free and independent movement, with diversity in its parts,
will be diminished, and evils which have fortunately been removed
may reappear.

You are aware of the different judgments which have been passed
on Gheel. Between the enthusiastic admirers of the system and
those who desire to see it entirely abolished is« a long list com-
posed not least of those whose faint praise scarcely conceals their
deep dislike. It cannot be often enough repeated that those who
give an unfavorable opinion of Gheel do not rely on their own per-
sonal observation, though that might have been expected in the case
of so peculiar a phenomenon. Of the many doubts which have

32 A Visit to Qheel ; [April,

been expressed regarding Gheel by those who have never been there,
and concerning which such tediously long dissertations have been
written, the greater part are disregarded by those who have investi-
gated the matter with their own eyes. Gheel has been compared
with the modem dosed asylums, especially with those which are
distinguished for extensive agriculture and the greatest possible
freedom of movement to the patients. After having, during a term
of five months' duration, visited a great proportion of the public
asylums of Germany, Holland, Belgium, and England^ which are
principally intended for the poor, and having found many excellent
ones among them, I stiU believe that Gheel and its system have
nothing to fear from the comparison. Let us not lose sight of the
fact that Gheel differs merely in degree from other asylums by the
great freedom which its patients enjoy, but that in the family life
there is a difference in kind, and also that it is this familv treatment
the great peculiarity of Gheel which strikes every visitor afresh. I
am far from denying that the majority of closed asylums boast with
justice of certain advantages over Gheel. In most, if not all of
them, the inmates are provided with brighter, higher, pleasanter, and
more convenient dayrooms, larger and more easily warmed bedrooms.
In many asylums, and especially in England, there is a better,
lighter, and more varied diet than is supplied to the insane poor in
Gheel ; and the nourriciers at Gheel can never be so continually
attentive to the patients as the attendants in a closed asylum have
at least the chance of being. But yet, although Gheel does not
possess handsome buildings, a beautiful view, broad parks, con*
venient arrangements, nor various games and amusements for the
patients, I have seen more happiness and contentment in its cottages,
more strength and self-possession among the insane, than' in the
palaces. And is it to be wondered at ? Who among us that has
lived for years in a public asylum has not often been filled with
sympathy for the sad condition of its inmates, and for the many
restrictions which they endure, not as the unavoidable consequence
of their disease, but only as the result of the system of treatment
to which they are subjected ? Who has not felt how much the
proper self-reliance and the manly dignity of these insane is injured
by the way in which we congregate them ? Does it not strike one
as frivolous to compare with a family a gallery of from twenty to
eighty persons, among whom besides there are to be found persons
of very different degrees of cultivation and of mental capacity?
He who is accustomed to the manners of the city is annoyed by the
boorish habits of his neighbour, and the tranquil patient by the
restless to-and-fro movements of the excited. The still sensitive
patient feels himself degraded by association with those sunk in
profound idiocy. His free movements are cramped by one or another
regulation which in the large population is indispensable for the

1867.] hy Da. Edmunb Nevschler. S3

tranquillity and order of the house. The bell which regulates his
daily life deprives him of any choice. The letters which he sends or
receives are read by those with whom he is not in confidential
relation. To the insane who feel these restrictions^ and there are
many sach^ the amusements with which we seek to compensate
them are felt as a burden. The strict separation of the sexes which
is necessary in large establishments deprives the intercourse and
games of the patients of one of the greatest charms of society. If
file patient is^ like a child in leading-strings^ taken for a walk along
with a number of his fellow-sufferers, how can he enjoy himself; for
as soon as he sees a sane person he is reminded of the unnatural
restraints by which he is separated from him. The only sane person
be sees regularly is his attendant, who is charged with the main-
tenance of every asylum restriction and regulation in regard to the
patient. As he is m so many cases beneath the patient in culture
and manners, these aimoying regulations become more annopng on
account of the person who carries them out. Besides, the attendants
in almost all public asylums are badly paid, and are thus deprived
of the most important condition disposing to the pleasant performance
of their duties ; and they are, at least, when unmarried, easily in-
duced to relinquish them. Set against all these evils, we have the
comfort of the arrangements which many are from their early habits
unable to appreciate ; certainly no compensation. In good asylums
the patients are subjected to little or no mechanical restraint, but
these moral evils are met with in all. A great proportion of the
patients are everywhere indeed too deeply depraved to feel them
acutely, but many others, especially the better educated, give them-
selves up silently to the inevitable; and their silence is almost more
eloquent than the complaints of those who complain loudly, and
frequently demand their freedom — their release from that confinement
which we had believed was made so comfortable and pleasant.
Every physician to a public, and especially to a large asylum, will
agree that the above-mentioned disadvantages of the only kind of
public care of the insane hitherto recognised cannot be got rid of,
and the endeavours to mitigate them forms a great and most dis-
tressing part of his vocation.

How much could I add if I were to describe not what must
always necessarily be, but the more marked features of what every-
where exists, if I were to speak of the general overcrowding of
asylums, and its effects upon the happiness of the patients. And
we daily practise vrith the greatest cahnness all these serious en-
croachments on the rights and on the freedom of individuals ; for
however much we may pity them, we regard these social conditions
as inevitably connected with the proper treatment of the insane.
Yes, we scarcely reflect on the greatness of these encroachments,
and we are, at aU events, firmly convinced that our therapeutics

VOL. xin. ^

34 A Ymt to Gheel; [A-pril,

are sufficiently advanced to overcome by their aid the distressing
effects which we produce upon the health of the insane. And
although hundreds of patients live at Gheel under natural conditions,
who, in any other country, would have been placed in a closed
asylum, and are just so many proofs of the injustice which we
practise towards that portion of the inhabitants of our asylums who
are suitable to this free kind of life ; with us they are shut out
from intercourse with the sane, which is their only proper inter-
course; there they live in active communication with them. All
their actions are superintended in a manner that could scarcely be
more perfect, as all the members of the family assist in this duty;
they form a circle about the patient in which he finds what he has
lost, or, perhaps, never possessed — friends and confidants. The
soothing voice of woman, which often tranquillises the excited, is
not wanting here, nor the merry laughter of the children, who try
to entice him to join in their amusements. Whatever kind of
capacity he still possesses is discovered, and he is encouraged to
make it useful; for he can always find some employment among
the various occupations of the house which will suit him ; and I
found one well educated patient when I visited Gheel who was
busily occupied with the work of secretary to a committee that had
been formed to enlist the interest of the inhabitants of Gheel in an
agricultural exhibition in Tumhout. He fulfilled this duty, which
required so much walking and talking, in the most satisfactory
manner, and obtained thanks from all quarters. The insane are
disposed to work for those who receive immediate profit from their
labour, and who must therefore in justice feel obliged to them and
value them. This kind of recompense, the indispensable stimulus
to all voluntary labour, is unknown to the inmates of the public es-
tablishments, and those who are acquainted with them have therefore
remarked how negligently the work there is generally performed.
And when those in very low mental condition are to be employed,
work must be resorted to which is not of the slightest use, and does
not even present the appearance of fruitful labour.

I have contented myself with indicating a few of what, in my
opinion, are the most important features in the life of those patients
at Gheel who belong to the poorer class. A few remarks now in
regard to the others. Gheel is a quiet and secluded place, whose
means of intercourse leave much to be desired. It is deficient in
the charm of a lovely view or interesting neighbourhood ; it has
neither a mild climate nor luxurious vegetation, and it has little to
show in the way of beautiful gardens and shady promenades.
Hence all those patients of the richer classes who have in the days
of mental health been accustomed to every luxury, are unsuitable
for being placed at Gheel. For such persons a pleasant, well-

1867.] hy Dr. Edmund Neuschlee. 35

situated, and well-conducted private asylum will always afford the
greatest opportunities of enjoyment.

* Allow me now, in conclusion, to describe to you the general
impression produced upon me by my visit. I am convinced, by
what I saw, that Gheel, in spite of many existing deficiencies,
presents an example of very good, and, indeed, for miany cases, the
best kind of treatment for the insane ; that the agricultural colonies,
the blocks, and similar modifications of public asylums which have
been recentlv introduced, will always be essentially different from
the system oi family treatment illustrated in Gheel ; that this system
is also suitable in most cases for the adoption of all modes of cure,
and excels any other in its influence on the mind; that it also
is more than any other compatible with the rights of the patients
to freedom and enjoyment of life. For this reason the future is its
own, and it wiU one day be the general mode of provision for the
insane, which by weighty reasons must justify itself against every
objection.

A verdict like this compels me to express my opinion as to the
conditions for extending the family treatment of the insane. The
possibility of this has been often denied even by the admirers of
Gheel, and the attempts which have been made have not been
hitherto very successful. And yet I recognise in the essence of
what is practised in Gheel nothing that is pecuhar to Gheel alone.
The religious aspect may be thought inconsistent with this opinion.
But those who have been at Gheel will coincide with me that, at
the present day, the peculiar reverence for St. Dymphna is certainly
no longer the motive principle of the treatment of the insane there.
The inhabitants have, for the most part, been for a long time
intelligent enough to perceive to what influences the cure, or at
least the health of the insane, is due. It is no longer superstition,
but that, practical philanthropy which is the soul of all religion,
that points out to them the true way to benefit the insane. Is it to
be asserted, then, that these sentiments are a special characteristic
of the inhabitants of Gheel ? Can they not be similarly aroused in
other places, and employed for the benefit of the insaue ? But, it
will be answered, the origin at least of Gheel depends on the local
bj^is of that religious service ; it is on.account of it that for more
than a thousand years the inhabitants have been accustomed to daily
intercourse with the insane, and have been freed from prejudices
which stUl cling to society at large. Certainly : but may not the
good which has been accomplished by superstition be elsewhere
obtained by judicious instruction ? Let a comprehensive and well
considered experiment be made in the right place and with sufficient
means, and let it be carried on perseveringly. Let a country neigh-
bourhood, with a good climate and detached style of dwellings, be
chosen, a neighbourhood which is little fit for manufacturing un-

36 A risit to Gheel ; L^pril,

dertakings^ but which contains a considerable extent of cheap land
not much built upon, a population not very opulent, but on the
contrary, unsophisticated, and hitherto remote from commerce, so
that they may be the more open to the influences that we wish to
put in operation. Let the good education of the children be pro-
vided for, and let a clergyman be found who is peculiarly adapted to
awaken intelligence and energy among those with whom he comes
in contact, and determined to use this influence in the furtherance
of our project; popularly written works might also be circulated
as an additional means of instruction. In the same locality let the
erection of an asylum be proceeded with, which at first would serve
as a closed asylum in the received sense of the word, but which
would afterwards be used for the same purpose as the infirmary at
Gheel. The physician to the asylum would have the carrying out
of this transformation. He would begin the transplanting of the
insane among the general population by placing them with married
attendants living in the vicimty of the asylum who might be ready
and suitable to receive patients, and for whom he would purchase
plots of ground, with the view of their settling there for a certain
period. Care would be taken, however, that this last proceeding
should be carried out as a permanent arrangement, as it would
burden the promoters of the undertaking with the purchase and
possession of extensive grounds, and the superintendence of their
proper management. These first cases should only serve as an
encouragement. But then there should be no interference with the
unrestricted movement of the population, and the free play of the
industry of any by a power which would be possessed of the ground
which is the basis of labour. If a commencement is made in such a
manner that quiet working patients should be placed with the
attendants at a rate of remuneration exceeding the expense of their
treatment, not only will the prejudices of the multitude soon be
removed, but the hope of gain, which is the most powerful engine in
all progress, will make many disposed to receive patients. The
more the distribution increases, the less will it be necessary to con-
tinue the payment of premiums which stimulated the spirit of
enterprise of the first applicants ; and the system would recommend
itself by its cheapness as well as by its other excellencies. Such an
undertaking could only attain: to any considerable magnitude in the
course of a decade. But I hope that this prospect will not prevent
a commencement from being made. On the other hand, it results
from this that the existing closed asylums, even though they may be
unsuitable for the transplanting of the insane among the neighbour-
ing population, have still a long future. The continually increasing
number of the insane requiring public provision will always present
a surplus which will be unfit for family treatment; and the asylums
furnish the only provision for the necessary clinical instruction in

1867.] hy Dr. Edmund Neuschler. 37

mental diseases. But the position of the physicians to closed asyliuus
will be rendered more satisfactory by an extension of the family
system. We will be freed from what we are at present subject to,
the consciousness that we are not only physicians in the service of
the public good, but also as regards one portion of our patients,
gaolers in the service of public prejudice.

Yours most obediently,

(Signed) Edmund Neuschler, M.D.

I believe that I only express the general feeling of the profession
in this country, when I say that we are always pleased to become
acquainted with the opinions of our learned brethren in Gtermany to
whom we already owe so much ; and we thank Dr. Neuschler for
his interesting letter. It would, however, show little appreciation
of the care which he has bestowed on the subject were we to receive
his conclusions without remark ; and I am sure that we shall best fulfil
his wishes by discussing the subject in the freest possible manner.

A decision upon the whole question may be arrived at if we can
answer the following questions satisfactorily: 1. Is the whole
system as actually carried on at Gheel, one which it would be
desirable that we should copy ? And if this should be answered in
the negative ; 2. Are any of its peculiar features worthy of being
adopted either in their entirety or with modifications P

The cases of patients belonging to the more opulent classes may
at once be excluded from consideration, as I oeUeve that most
persons will agree with Dr. Neuschler, that the greatest possible
advantages are secured for them by the system generally adopted.
The question is thus narrowed to a consideration of how far Gheel
presents a satisfactory mode of providing public accommodation for
the insane. .Those patients also, whose tendencies are markedly
dangerous to themselves or others, or whose habits are of a destruc-
tive character, are generally regarded as unsuitable, and are pro-
fessedly excluded from Gheel.

Let us then endeavour to reply to the first of the questions
which I have proposed : Is the whole system as carried on at Gheel
such as should be imitated ? I fear that a very short examination
will satisfy us that it is not. In spite of the condemnation which
the large amount of restraint has received from most of those who
have visited Gheel, it does not appear to be satisfactorily diminished.
In 1856 the total number under any form of restraint was given as
69 among 774 patients. Dr. Snell,* director of the asylum at
Hildesheim, reports that at his visit in 1862, about 60 patients
wore fetters on the ankles, and that the number of strait-jackets and

* "Yerliandliingender psychiatrischen Section in der Natnrforscher-Versamm-
\mg zu Oiesften, September, 1864," ' AUgemeine Zeitschrifb fur Psychiatrie,' voL
xxi. Supplement.

38 A Visit to Gheel; [April,

restraint girdles was proportionately large. Dr Brosius,* director
of the private asylum at Bensdorf, near Coblentz, estimates the
total number as probably reduced by a half since 1856. Dr.
Webster, in 1866, 'Mearnedthat the daily average of persons under
even temporary restraint by manacles seldom, if ever, exceeded
twenty examples ; while those who had hobbles to prevent straying
in fields adjacent, by records kept, rarely amounted to five in-
stances.^^ He ^^ heard of none being confined by strait-waistcoats,
or analogous appliances. Dr. Neuschler says that the use of
mechanical restraint is much circumscribed. Dr. Webster seems to
think that at the time of his last visit the only case of seclusion was
one female patient whom he found in the infirmary; but Dr.
Neuschler reports that its use is only much circumscnbed; and in
the preceding year Dr. Brosius seems to have found several in
seclusion, and others wearing the strait- waistcoat. An indication of
the feeling with which seclusion is regarded by the nourriciers is
given by the last-named observer, who "asked a peasant woman
why her patient was locked up.*' The reply was, "she is cross
(bose) to-day.^' Dr. Snell says that "in the neighbourhood of
Gheel patients are often seen shouting and reviling at the windows
of the chamber in which they are shut up.^' It is to be feared that
the authorities are not yet prepared to remove the iron stanchions,
as Dr. Neuschler recommends. We need not raise the question
here whether mechanical restraint is ever necessary, as the majority
of our continental brethren hold very different views of the subject
from those prevalent in this country. But whatever may be
thought of its use in asylums, it ought surely to be banished from
a place whose chief claim to admiration is the absence of asylum
restrictions, and the preservation of the kindly associations of family
life. In the account of a visit to Gheelf which I made in 1860, 1
expressed the opinion that cases requiring restraint should be
excluded from Gheel. In 1862, when I again visited the colony,
this opinion was impressed, if possible, more strongly on my mind.
But hopes were entertained that the use of such appliances would
soon be discontinued. As these hopes have hitherto been dis-
appointed, it appears desirable that emphatic disapproval of their
use should be recorded by the profession, so as to hasten the neces-
sary reform, and I do not doubt that no one would rejoice more at
their abolition than Dr. Bulkens himself.

Besides the incompatibility of the spectacle of manacled, and
girdled, and hobbled patients, with the feeling of freedom and
family life which it is the aim of Gheel to preserve, every alienist
must recognise the necessity for such cases, of having a more

* "Naturforscher-Versammlung zu Hannover, September, 1865," * Allg. Zeit.
f. Psych.,' vol. xxii.
t * Journal of Mental Science,' April, 1861.

1867.] hi/ Dr. Edmund Neuschlbr. 39

thorough supervision than can be carried out at Gheel. The long
experience and ability of the nourriciers, which are so useful in
many ways at Gheel, are not unmixed benefits when the treatment
of refractory patients is concerned. It is well known that in the
oldest asylums the greatest care is necessary on the part of the
superintendents to check the employment of ingenious but improper
proceedings which have, from time to time, been introduced by
attendants for their own ease, though not for the patient^s good. I
am acquainted with one eminent medical superintendent who will
not engage an attendant who has previously been on the sta£P of
another asylum, on account of the danger of his importing some
new mischievous device. In such a place as Gheel it must be
almost impossible to prevent these objectionable proceedings so long
as a class of patients supposed to require restraint is admitted. It
must also be borne in mind that the tranquillity that characterises
the town is accounted for by the practice which, according to Dr.
Webster, is still followed, of placing "boisterous and agitated
maniacs at remotely situated cottages or farm-houses located in open
heaths, distant from the town, where, having few neighbours, they
cannot disturb any insane patient, or cause much annoyance.
This arrangement has evidently the effect of removing the class of
patients chiefly requiring supervision, to a position where efficient
supervision is impossible.

Another class of patients at Gheel who ought to be excluded is
composed of those who desire to escape. The existence of tliis
desire is sufficient proof that they are ^scontented with their con-
dition; and as the nourriciers have to .pay the expense of all
escapes, such patients are either fettered, or watched with a jealousy
more irksome than confinement in an or^nary asylum could be.
'' We met,^^ says Dr. Brosius, '' a German in Gheel, a patient from
Cologne, who complained bitterly of the want of freedom, and was
micommonly glad when, with the permission of his host, we took
him for a walk through " the town. He had once made his escape,
and the expense having been defrayed by the nourrider, that other-
wise humane host never afterwards permitted him to cross the
border of the plot of ground attached to the house. Is that free-
dom?" According to the Gheel reports up to 1860, the average of
escapes of whose after fate no information is given, was 3*4 per
cent, on the admissions. In these cases either no necessity existed
for their detention in Gheel or any asylum, in which case it was
wrong to send them there, or if such necessity did exist, it was
unfortunate that Gheel was selected. I think it is also obvious that
all paralytic patients, and those suffering from severe bodily ailments,
or having a tendency to dirty habits, would be much better provided
for in an asylum under more complete supervision, and furnished
with the usual hospital appliances.

40 A Visit to Gheel; [April,

Let us now consider the question from a purely medical point of
view : Are patients more frequently cured in Gheel than in other
asylums, or do they enjoy greater bodily health ? A paper which
deals with the subject in this manner was published by Dr. 1\
Wiedemeister,"*^ in which he forms a very low estimate of the
medical value of Gheel ; but it appears to me that he has left some
important considerations out of view when forming his opinion.
One great difficulty presents itself in the fact that Gheel receives
so many incurable cases from other asylums; and I am not at
present in possession of data to indicate exactly to what extent this
occurs. If, in the cases admitted, we compare the duration of
insanity previous to admission, with similar statistics in ordinary
asylums, we find that Gheel contains a less curable population than
they do. Out of 527 admitted to Gheel, 192, or only 86 per cent.^
were cases of less than ten months' previous duration, and probably
about 40 per cent, would be under a year, so that there would be
60 per cent, of chronic cases among the 527 admissions. Let us
compare this with what has been found in two asylums, one English
and one American, the statistics of which, in regard to this point,
are fully given in these reports; in Prestwich asylum from 1851 to
1865, and in Worcester (Massachusetts) Asylum from 1833 to
1864.

Admissions ^er-centage of Per-centage of
recent cases, chronic cases.

Gheel 527 40 60

Prestwich 3948 68 32

Worcester v- 7104 65 35

The proportion of recent cases admitted to the two asylums is
about double the number of chronic cases ; and to put Gheel on an
equality with them on this point, two thirds of its admissions of
chronic cases would require to be excluded, which would diminish
the entire number by 40 per cent. By this means we arrive at the
probability that 316 of the 527 were cases possessed of equal
chances of recovery with those usually admitted to asylums.

If we now take the recoveries for the year, and compare their
number with these 316, we find that 100 have been discharged
recovered, or 32 per cent, of those admissions which afforded an
average chance of cure. In the report of the Essex Asylum for 1865
a very interesting table is given by Dr. Campbell, in which are
presented the statistics of recoveries and deaths in the county
asylums of England for the previous five years. From his data it
appears that the average proportion of annual recoveries to ad-
missions was 36 per cent., two asylums having less than 22 per

* " Ueber die Leistnngen des Gheeler Systems. Anszng aus einem dem Minis-
terio des Innem nnterbreiteten Beiseberichte," 'Allg. Zeit. f. Psych./ vol. xzi.

1867.] hy Dk. Edmund Neuschler. 41

cent., and one having the large proportion of 51 '5 per cent. It
thns appears that in curative efficacy Gheel must he regarded as
below the average of ordinary asylums, and we must, prhaps,
regard it as considerably below if we take into consideration that
what are counted as recoveries there, include not only guSrisons, but
also ameliorations notables.

The general health of the patients at Gheel can be estimated with
less hesitation as the circumstances which disturb the last calcula-
tion will not materially aflfect the rate of mortality. During the five
years ending 1865, during which there Was an average of about
1000 patients resident, the deaths amounted to 409, or 12 per cent.
per annum. The average mortaHty in the English asylums, as
computed from Dr. Campbell's table, is 10 per cent., the highest
being over 14 per cent., and the lowest under 6 per cent. Gheel
may consequently be said to be nearly on an equality with ordinary
asylums in this particular.

We must thus refuse to acknowledge in the family system as a
curative agent that superiority over the ordinary asylums which
Dr. Neuschler and some others would claim for it ; and we now
come to the question. Is there any part of the system which may be
regarded as an improvement on ordmary asylum treatment ? Almost
all those who have visited Gheel report that a great many of the
patients were happy and industrious, while there can be no doubt
that the expense of their maintenance is considerably below what
would defray the expense of asylum treatment. And there can be
no doubt that the example of Gheel has done more than anything
else to teach us how great a degree of liberty may be granted
to a large portion of the insane, and has stimulated the construction
of asylums divested of those special characteristics which were
formerly regarded as necessary for the care of the insane. So far as
the insane can be treated efficiently without the erection of asylums,
80 far is it for the advantage of themselves and of the public that
they should be so treated. It would be desirable, then, that the
experience of the authorities at Gheel should be of such a character
as to teach us precisely the description of cases to which family treat-
ment is suitable. But this is just the information that the attempts
to admit patients so promiscuously prevent us from obtaining.
What we want is that all the unsuitable cases should be eliminated,
and that we should then be made aware of the nature of those cases
which remain. Until this is done it cannot be regarded as a guide
to asylum reformers ; and we must advance slowly and by the aid
of othei: experiments in the determination of the proportion of
pauper insane who may be excluded from asylum treatment. An
attempt is being made at present by the General Lunacy Board for
Scotland to determine this point; but as yet there is no general
agreement as to the number which may be provided for in private

42 A Visit to Gheel ; [April,

houses, though all seem inclined to the opinion that more may be
done in that way than was recently supposed. My own opinion is
much the same as it was after my ifirst visit to Gheel. There seem
to be ^^ two classes of cases which more than any other derive benefit
from this system. One class comprises the milder forms of acute
mania, many of which may be successfully treated, though at first
sight it would appear that their excitement would require that they
should be more closely confined as a protection to themselves and
others. The other consists of partially demented cases who have
either through old age or other causes fallen into a second child-
hood.^^* If I would modify this opinion, it would be by speaking
with less confidence of the propriety of placing with families patients
labouring under even mild forms of acute mania ; and it is probable
that a large number of the demented class who are suitable will be
found among congenital cases. The labours of Dr. Mitchell and
Dr. Paterson, in Scotland, give greater promise of affording useful
information regarding these points than any indications which we
have received from Gheel. Many difficulties will have to be over-
come by these gentlemen, and that they are being satisfactorily
grappled with appears from their published reports. Tn the report
for 1865, Dr. Mitchell statest the principles on which the Scotch
board are acting, and gives such an exceUent resume of the whole
subject, that I take the liberty of transcribing it. I believe
the view on the whole to be, as he states it, a correct one ; but
I think I would have more fear of trusting the very idiotic or fatuoUs
to the cottage treatment than his experience seems to lead him to.

In any scheme making provision for the insane poor, the erection
of pnbhc asylums '^constitutes a first feature — a sine qua non.
By this, however, it is never meant that they should be large
enough to hold every person in the country who can be duly
certified as insane, or even that all such persons would be the
better of being placed there. What is meant is this, that public
institutions, with every appliance which skill and humanity can
suggest, should be created and kept ready for the reception of those
lunatics in the treatment of whose disease those appliances are
valuable and necessary, and also for the safe and comfortable
keeping of those lunatics who, though not curable, are unfit to be
at large, because they are dangerous to themselves and others, and
in whose management safety cannot easily be combined with comfort,
except in a home constructed and designed for that purpose,

" These two classes being thus provided for, there remains a third
and very numerous class, consisting of insane persons quite beyond
all reasonable hope of cure (many, indeed, being congenital idiots or

* Loc. cit.

t 'Appendix to Seventh Report of the General Board of Commissioners in
Lunacy for Scotland^' 1865.

1867.] ly Dr. Edmund Nbuschi.er. 43

imbeciles) who are easily managed, and inoffensive under kind and
judicious treatment. These persons do not require the costly
appliances of an asylum for their proper care, and to place them in
asylums would not add to their happiness. Though of unsound
mind, though unable for that cause to support themselves, though
in constant need of guidance and help from others, they are, never-
theless, capable of enjoying an individuality in their existence ; they
appreciate the amenities of domestic life and the pleasure of free*
dom ; and they are often affectionate, gentle, and biddable. This
description rests on an acquaintance with this class of the insane
which has become large in the discharge of my duties.

" If the costly appliances of an asylum are not necessary for the
proper care of such lunatics, it is not necessary for the country to
resort to them, especially since it appears that the doing so would
not benefit or increase the happiness of the patients themselves.
The consideration of cost is a proper one, and should not be over-
looked. Lunacy is a great public burden, and every proper thing
should be done to prevent an unnecessary increase. Unless some
remedy be appUed, we have already proof that we shall have that
happening in ScoUand which has happened in England, where, in
the last fifteen years, pauper lunatics in asylums have risen from ten
to twenty-two thousand, without exhibiting any diminution in the
rate of increase, and where there is a constant demand for increased
asylum accommodation.

*' It is believed that, through the provisions of the Scotch Lunacy
Act in reference to single patients, and patients in houses with
special licenses, the remedy for at least a part of this evil is found,
since through them a satisfactory, inexpensive, and natural way of
disposing of a certain class of the insane is afforded— of that very
class, it must be remembered, whose number shows the tendency to
increase. Of the working of the provisions there has now been a
sufficiently long experience to justify this opinion.

'' Of cases of acute or active mental disease received into asylums
for treatment, only a certain number are cured. Many of the rest
pass into fatuity, or their disease becomes chronic, inactive and
perfectly incurable. Not a few of these last belong to a class of
the insane who may be provided for in the way just described. All
asylum populations which have been gathered slowly consist, in a
considerable proportion, of this class. It is their accumulation
which fills the asylum ; and it is their withdrawal and transference
into private dweUings which ought to give relief and allow the
asylum to fulfil its higher objects.^^

44 [April,

Recent Contributions to the Pathology of Nervous Diseases.^

When we reflect that the sciences of astronomy, physics, and
chemistry have only recently got rid of the metaphysical spirit, we
cannot wonder much that physiology is not yet entirely emancipated
from the pernicious thraldom. It was plainly impossible that
physiology should be cultivated in the spirit of the positive method
of investigation while the sciences upon the advance of which its
advance is dependent were not sciences at all, but clouds of idle and
shifting fancies. But there has been another and weighty reason
why the science dealing ynth the structure and functions of the
organism has remained so long in a metaphysical bondage : because
psychology, the last stronghold and the forlorn hope of the meta-
physical method, is an important branch of it. Metaphysicians
nave for at least two thousand years been supremely self-satisfied to
evolve, from the unfathomable depths of the inner consciousness,
ingenious mazes of vague and ill-defined words which they have
dignified with the name of mental philosophy ; and the consequence
has been that the physiologist, when he came in the course of his
inquiries to the brain, contented himself with the anatomical de-
scription of it, and never dreamed of studying its functions as the
mental organ. By a prescriptive right, sanctioned by the authority
of generations, mind belonged to the metaphysician; audit naturally
seemed sacrilegious to venture a scientific step in such holy ground.
Not only so, but the mischievous influence of the metaphysical
spirit spread beyond the department of psychology, and infected more
or less strongly all physiological inquiries. However, this state of
things could not last in face of the active progress of positive science ;
the organs and functions of the body became objects of positive in-
vestigation, and even the brain no longer escaped scientific study.
So it has come to pass that the germs of a mental science having a
physiological basis have appeared, and now threaten to disturb the
ancient ascendancy of metaphysical mental philosophy. The present
position of matters is this : there are two systems of philosophy
dealing with the same subject, but not having the slightest connec-
tion one with the other, and cultivated according to different methods
by different men — ^metaphysical mental philosophy and positive mental
science. A man might be deeply learned in all the wisdom of the
former, and yet entirely ignorant of the very meaning of the simplest
facts of the latter. It is hardly worth while considering seriously at

* "Observations on the Pathology of Diseases of the Nervous System/' by
Samuel WUks, M.D.; 'Guy's Hospital Reports/ 1866.

1867.] Contributions to the Pathology of Nervous Diseases. 45

the present day which of these rival systems is likely to prevail over
the other ; one of them is the latest issue of the advance of positive
science, has its foundations deep rooted in the relations of natural
laws, and exhibits a promising growth ; while the other has moved
in an everlasting circle, has no better foundations than the clouds and
conceits of men^s thoughts, and exhibits symptoms of active decay.
Now and then it is skilfully galvanized into a spasmodic semblance
of life, but each artificially excited convulsion is plainly the fore-
mnner of an increase of the inevitable paralysis. Much remains to
be done, however, before we can claim acceptance for a positive
mental science. Not only is our knowledge of the structure and
functions of the brain very defective, but there is nothing like exact
information to be had regarding its pathology. It hais been the
fashion to give the name of some disease to a group of symptoms,
without attempting to connect these with particular diseased states
of the nervous centres. The pathology oi all the diseases of the
nervous system is, it must be confessed, in a most unsatisfactory
condition.

What then, briefly summed up, have been the errors of times past,
and what are the hopes of time to come ? The errors of the past
have been the^e : first, that metaphysicians have usurped the wnole
domain of mental phenomena, and have reared therein an unreal
system of philosophy such as they reared in every other department
. of nature until they were forcibly driven out of it; secondly, that
the physiologists, imposed upon by the pretensions of the meta-
physicians and weighed down by the metaphysical conception of
mind, have not dared to apply to mental function and to the brain as
its organ the positive method of investigation which they applied
with success to other organs and their functions ; and, thirdly, that
pathologists, influenced by the superstitious feeling of mind as an
incomprehensible mystery as well as by the vast difficulties in the
way of the study of the pathology of nerve element, have made little
or no use of the great quantity of instructive material lying ready to
their hands. What are the hopes of the future ? They are these :
first, that metaphysics, having played out its part, is now passing
quickly off the stage; secondly, that an inductive psychology,
founded on the faithful observation of nervous and mental phe-
nomena, is coming on the stage; thirdly, that physiologists and
physicists are now earnestly devoting themselves to a close study of
the different parts of the nervous system with their different func-
tions, and to the investigation even of the intimate conditions of
activity of nerve element ; and, lastly, that pathologists are likewise
zealously engaged in tracing the connection between particular
diseases and morbid states of the nerve centres, and in researches
into the nature of the morbid changes. Thus the labours of psycho-

46 CofUributions to the Pathology of [April,

legists, physiologists, and pathologists are converging to a focus, and
bid fair to meet ere long in a fruitful harmony of action.

The contributions, by Dr. Wilks, to the pathology of nervous
diseases in the last volume of the Guy's Hospital Eeports are an
important effort to place the classification of them on a scientific
basis. They cannot fail, therefore, to be of great use indirectly
to psychological and physiological progress, as well as directly
to increase our pathological knowledge and to render it more
available by a better method of classification. We propose, then, on
the present occasion to give an abstract of the results of Dr. Wilks's
studies of nervous diseases, interposing such commentaries as may
suggest themselves.

Duease of the central ganglia; hemiplegia, — An alteration in
structure leading to a loss of function of the corpus striatum and
thalamus opticus — whether the alteration be due to softening, effusion
of blood, or embolism of the middle cerebral artery — ^produces a
hemiplegia of the opposite side of the body, but no disturbance of
the intellectual faculties. Although the term hemiplegia denotes
that one half the body is paralysed, it is not really so ; the trunk is
unaffected, owing to the centres of the pneumogastric and other
respiratory nerves being in the medulla, and escaping injury. In like
manner the mind remams unaffected, because the nerve centres of
intelligence, consciousness and will — the cerebral hemispheres — are
not implicated in the mischief. An interesting question here presents
itself : can the will act directly upon the uninjured nerve centres of
the non-paralysed parts, or can it act on them only indirectly through
the large ganglia ? In other words, is there a direct communication
between the uninjured centres that lie below the damaged ganglia
and the supreme hemispherical centres or not ? Anatomists teach
that there is such a direct communication by which an immediate
influence may be exerted; but clinical observation has not vet
given decisive information on the point. Dr. Wilks concludes, that
if the will continues to influence the movements of the chest in a
hemiplegic person (of which he caimot speak with certainty), ^^ either
there must oe some connection between the seat of volitional power
and the centres of the chest nerves, independent of the large ganglia,
or else the regulating centres must be so associated that a stimulus
to one side can affect both.''

The loss of speech which so often accompanies right hemiplegia
is not easily explained. Dr. Wilks, however, thinks there is much
truth in the mgenious theory propounded by Dr. Moxon : that it
arises from the two halves of the body being unequally educated, or
rather from one half bemg specially educated, as is notably the case
m writing and in many movements of the limbs. When a person
has hemiplegia of the right side he cannot write, the guiding power

1867.] Nervous Diseases. 47

which appears to exist only in the left corpus striatum being abolished
by the disease. Were it possible to put the right corpus striatum
in the place of the left, would he then be able to write ? Probably
not; and why? Because the right corpus striatum has not been
educated for that purpose. In like manner it is supposed that one
half the brain is specially educated for speech, which will accord-
ingly be abolished by a certain amount of disease on the left side.
To us this hypothesis, ingenious as it is, appears to be without real
foundation ; and if we were to make any comparison of the action
of the two halves of the brain, it would rather be with the action of
the two eyes. A person may see with the one eye, or with the
other eye, or, as he usually does, with both eyes ; and so we believe
that a person may think with one half of his brain, or with the other
half, or with both halves, and that speech, in its mental aspect as
the expression of ideation, is coextensive with thought, and by no
means confined to either side of the brain. Besides, if the hypo-
thesis be true, what becomes of the statement systematically made,
and not contradicted, that one hemisphere of the brain may be
entirely destroyed without injury to the intellectual life ; the only
noticeable consequence being a greater irritability and an earlier
exhaustion from exercise in some cases. Lastly, how is the hypo-
thesis to be reconciled with the undoubted existence of loss of speech
in some cases of left hemiplegia ? Was the patient right-speeched^
not otherwise than as a person is sometimes left-handed P Other
objections might be made, some of which will be found in Dr.
Alexander Eobertson^s thoughtful paper on "The Pathology of
Aphasia'' in the last number of this Journal; but the fundamental
one is the absence of any real analogy between loss of the motor
power of writing and loss of speech as a mental faculty. Dr.
Bobertson thinks it " inconsistent with the general plan of nature
that a part should have been created simply to remain in an un-
developed condition,'' as Dr. Moxon's hypothesis assumes certain
parts of the right side of the brain have been. We should not
attach much importance to this argument, not being wise enough to
know what is the general plan of nature, nor acute enough to see
that it is inconsistent with nature's plan to do many things without
any useful purpose. In fact, those who think of the mammary
gland and the nipple in the male animal, or of the abortive brain
of the congenita idiot, or of a hundred other such instances of
nature's useless fertihty, may be disposed to sympathise with Geoffrey
St. Hilaire, when he says — " I cannot make of nature an intelligent
being who does nothing in vain ; who acts by the shortest mode ;
who does aU for the best." Nature, struggling as man does through
&ilures to success, makes many bungles, some of which men mend
by means of art ; but as man is a part of nature, it is after all

48 Contributions to the Pathology of [April,

nature which ''makes that mean^^ and therefore in the end mends
herself.* Only we should take care in our reflections to allow long
enough time for this improvement and development : without question
nature's skill is greater now than it was five thousand years ago —
her lands everywhere decorated with a more beautiful art, and
covered with more various and more fruitful crops, and her children
stronger, better and wiser; and she is still only in her early

irouth. What are a few thousand years in the history of a deve-
opment where centuries are but seconds? We mast beware
then of limiting nature's doings by our ideas of what her plans
are, or of attributing a perfection as end to what may be only
means in a developmental progress. In her failures and blunders
there is the earnest of a new success ; in her successes, the presage
of new failures on a higher platform of development ; the rudimen-
tary organ of one animal is the prophecy of the higher animal in
which it shall arrive at its full development ; the fully developed
organ of the lower type marks a grade of development again to be
witnessed in the d^enerate organ of the higher type. Not to
ramble further in this digression, however, let us return to the other
arguments which Dr. Eobertson uses against Dr. Moxon's theory.
'' Besides, as his theory is based on the greater attention to the
movements of the right hand than the left — arguing from that fact
a probably greater attention to the right side of the tongue than the
lerib (memory accumulating on the left side of the brain, where he
thinks attention is fixed) — ^it follows that left-handed people ought,
when aphasic, to have their hemiplegia on the left side, which joo**ii/y
is the case. Again, how does it happen that even after nineteen
years, as in one of my cases, during which, according to the theory,
attention ought to have been transferred to the left extremities,
memory has not gradually gro^Ti up in the right hemisphere ?''

When brought face to face with a person suffering from loss of
speech, the first question plainly is to determine what is the loss. Is
it a loss of the power of giving articulate utterance to the ideas, of
making the vocal signs of them \ or is it a loss of speech on its
mental side — ^in other words, of ideational function? It is quite
possible for a person to lose the power of expressing himself by

• " Ferdita. For I have heard it said.

There is an art which, in their piedness, shares
With great creating nature.
*' Polixenes, Say there be ;

Yet natnre is made better by no mean.
Bat nature makes that mean : so, over that art.
Which, you say, adds to nature, is an art
That nature niakes.

This is an art
Which does mend nature, — change it rather ; but
The art itself is nature.*'— TFiwfer** Tale,

1867.] Nervous Diseases, 49

speech without the intelligence being at all affected, the ability to
express himself by writing remaining: he loses the mechanical
power of registering his thoughts in a certain way by reason of
damage to some part of the instrument which he has to use. Either the
communication between the ideational centres and the motor centres
of speech is interrupted; or the mechanism of the motor centres in
which reside the motor intuitions of speech is damaged and their
functions suspended; or the communication between the motor
centres and the muscular apparatus is cut off. In all these cases
the lesion is a motor one, and the question a question of paralysis,
just as it is when power of writing is lost in consequence of right
hemiplegia. And as in some cases of hemiplegia a strong emotion
may suffice to move a paralysed limb when no effort of the will can
move it, so here a strong emotion may sometimes enforce its ex-
pression in speech when volition cannot.

Now, before saying anything of loss of speech in its intellectual
• aspect, let us ask what are the probable motor centres of speech —
what are the motor nuclei in which are stored up the residua of all
the previous motor, acts of speech ?* Some seem inclined to beheve
that the corpora striata contain the motor nuclei of speech, and that
therefore it is that loss of speech so often accompanies hemiplegia
depending on injury to the corpus striatum. Dr. Jackson, whose
labours in the study of the different forms of paralysis are so well
known, would probably suppose that disease of the left corpus
striatum producing right hemiplegia must cause a loss of the power
of articulation ; and with this view Dr. Wilks apparently coincides.
But there are no arguments, so far as appear, atfordiag support to
the opinion that the motor centres of speech are situated in either
corpus striatum, while there are reasons for believing that they are
not so placed. Disease of the corpus striatum and hemiplegia occur
without any loss of speech; and loss of speech occurs without dis-
ease of the corpus striatum and hemiplegia. Where then are these
centres situated ? In reading Dr. Wilks' remarks, it has been a
surprise to find no reference to the views of Schroeder van der Kolk
on this subject. Arguing from the facts — (1) that the two corpora
oKvaria are reciprocally united by a considerable number of fibres,
arising from their ganglionic cells and perforating the raphe ; and
(2) that the corpus olivare of each side is closely connected with
the nucleus from which the hypoglossal nerve of the same side
originates, that eminent anatomist concluded that the corpora
olivaria presided over the movements of the tongue in articulation.
This view is confirmed in some measure by comparative anatomy ;

* The rendua of the motor acts of speech : — ^These are the foundations of what
may be caUed the motor intuitions of speech — what have been designated by the
Oermans Bewegungsanschauangen, For a fuUer account of this department of the
mental functions than would be proper here, I may refer to the chapter on
*• Actuation" in my work on the * Physiology and Pathology of the Mind*

VOL. XIII. ^

50 ContrilfutioM to the Pathologt/ of [April,

for the corpus olivare exists only in a small number of animals —
only in mammalia^ and is most developed in man, the apes coming
next in order. The facial nerve has connection with it through a
group of ganglionic cells or auxiliary ganglia on a level with the
nerve and closely connected with its nucleus — a circumstance which
may afford some reason to suppose that the loss of speech and the
facial paralysis accompanying hemiplegia are concomitant effects of
a common cause, whether this be the direct encroachment of disease
or some secondary consequence of it. If the hypothesis of Schroeder
van der Kolk be true, a question will arise, whether the will can act
directly upon the corpus olivare, or whether it can act only through
the corpora striata. It is indeed a part of the larger question
whether all the fibres of the sensori-motor tract end in the thalami
optici and corpora striata, new ones starting thence to go to the
hemispherical cells, or whether some pass directly onwards to the
surface of the brain. It may well be that all the nerve fibres from
the limbs end in the thalami optici and corpora striata, and yet that '
there is direct communication between the grey surface of the hemi-
spheres and the special nuclei, motor and sensory, that lie in the
cerebro-spinal tract below these ganglia.

Coming next to the consideration of speech in its mental aspect,
is it really a matter for serious discussion whether the faculty of it
is placed in a particular part of a particular convolution on one side
of the brain ? If it be so placed, then it is an unavoidable psy-
chological coroUary that thought is located there also — a reductio
ad abiurdum which might well stagger the hottest theorist. When
the mental faculty of speech is affected, the defect is not a motor
one, nor is the question one of paralysis (although it is possible
there may be paralysis of speech also), but the defect is mental, and
the question is one of ideational disturbance or deficiency ; the loss
or disorder of speech being an index marking the degree and kind
of the mental failing. For a man to exhibit intelligent utterance
under such circumstances would be very much as if the notes of a
piano were to go on vibrating in the harmony of a tune after the
player had ceased playing, or when his fingers were striking discords.
In how many cases of hemiplegia without loss of speech does the
mind escape entirely ? Is it not the usual fact that, though con-
sciousness remains, the memory, the emotions and the mental power,
are more or less affected in hemiplegia? Superadd loss of speech
to the mental failing, or suppose a greater degree of secondary dis-
turbance produced in the supreme centres of intelligence by the
primary mischief in the corpus striatum, and we may conceive the
conditions of any sort of imbecDity of thought, memory, and ex-
pression.

But, it may naturally be said, the foregoing observations can have
weight only an the supposition that the observations and inferences

1867.] Nervous Diseases, 51

made respecting loss of speech and disease of the left corpus striatum^
or of the left frontal convolution, or of both, have no weight. True :
the frequent association of right hemiplegia and loss of speech counts
for nothing as an argument in favour of the conclusions which have
becD based upon it, so long as cases are met with, as they certainly
are, in which there is left hemiplegia with loss of speech. A
generalisation is unsound which is met bj a positively contradictory
instance, when that instance' cannot be explained by any variation
of circumstances intervening to disturb the operation of the general
law, and thus, by accounting for the exception, confirming the law.
The true problem is to find out how it is that loss of speech n^ore
often accompanies right tlum left hemiplegia, not to set up the
hypothetical cause of a necessary coexistence, and thereupon to
invent other hypotheses in order to account for the actual variations.
There would certainly appear to be conceivable other anatomical
reasons for the frequent coexistence of loss of speech and right hemi-
plegia more likely than the localisation of speech in one part of one
side of the brain. It is hardly necessary then to add that the
observations of disease of the posterior part of the third left frontal
convolution, which have been reported with a remarkable family
hkeness ever since M. Broca promulgated his singular theory, inspire
no confidence whatever. It requires a person to have studied the
morbid anatomy of the brain nearly aU his hfe in order for him to
be trustworthy as a guide to what is a merbid condition of it. And
the way in which many of these cases have been related, when they
are critically looked into, can scarcely fail to excite doubt and sus-
picion, not of the sincerity of the reporters, but of their scientific
competence and of their freedom from unconscious bias. How fre-
quently, in fact, do we find in such cases an elaborate account of
the symptoms during life, and, when we come to the description of
the morbid appearances, little more than that ^^ there was softening
of the posterior part of the third left frontal convolution'* — little
more than the exact repetition of Broca's theory in Broca's words.
A great difficulty in observation notoriously is, not to see what is
specially looked for, but to avoid seeing it. Apart, however, from
all question of the reUability of pathological observations, and apart
from all psychological considerations, the fact that loss of speech
has occurred without any affection of the left frontal convolution,
the not less decisive fact that the left frontal convolution has been
destroyed by disease without any loss of speech, and the further fact
that loss of speech does occur when the disease is on the right side
of the brain, render it unnecessary to discuss Broca's theory on
the basis which some have hastily claimed for it.

To prevent a possible misconception in regard to the foregoing
cursory criticism, it may be well, before passing from the subject, to
add one reflection more. It is this : that a liinited disease of the

52 Contributions to the Pathology of [Aprils

brain, such as abscess or softening, confined to the medullary part,
or situated elsewhere, may affect the intelligence in one case and not
in another, or at one time in one person and not at another ; the
eflFect being due probably to that ooscure action which we provision-
ally designate reflex or sympathetic action. I have seen a patient,
whose death proved him to have limited abscess of the brain, devoid
of all intelligence and utterly unable to express himself in any way
at one time, and at another time suddenly to recover his intelligence
and to speak quite sensibly, although the restoration was only
temporary. The example might serve to prove, were proof on such
point necessary, how completely in some cases limited mischief may
affect the whole mind; it may also enable us to conceive how it is
that disease of one of the corpora striata does sometimes disturb
seriously the intelUgence.

Disease of the pons varolii. — Disease on one side produces hemi-
plegia with or without some other local paralysis ; a disease in the
middle of the pons may involve both sensory and motor tracts, and
cause a complete . loss of power of the whole body. Though a
sudden effusion of bbod usually produces profound coma with con-
traction of the pupils, there is not necessarily any loss of conscious-
ness. The imphcation of one or other of the numerous nerves
arising from this part will afford evidence as to the part of the
sensori-motor tract affected^ the facial, the fifth or the sixth nerve
may be paralysed, and the fibres of the lingual and glosso-pharyngeal
are involved when the disease is low down towards the medulla.
Dr. Wilks relates three cases of disease of the pons, in all of which
there was loss of speech, and other cases to show how closely the
symptoms of apoplexy of the pons sometimes resemble those of
opium poisoning.

Paralysis in connection with disease of the surface^ — If a patient
is quite unconscious, his limbs will fall helpless when they are
raised ; but is there a real paralysis in every such case, or is the
result due to loss of volition ? In fact, is disease of the surface of
the brain sufficient to produce a real paralysis, or is an extension of
disease to the motor centres necessary to bring about such effect?
Dr. Wilks relates pne remarkable case in which there was retention
of consciousness with left hemiplegia, and in which after death the
whole cineritious substance of the right hemisphere was soft and
disintegrated, the disintegration reaching the medullary matter, but
hot penetrating deeper. The left hemisphere was quite healthy.
The example, if, as Dr. Wilks observes, the report can be reUed
upon, might certainly seem to prove that disease of the surface of
the hemisphere may produce hemiplegia. The patient, a woman,
was quite unaware that she had lost power over her left side. But
was me existence of a real paralysis satisfactorily established in the

1867.] Nervous Diseases. 53

case ? Or is it possible that the helplessness of the left limb was
after all due to the loss of volition and consciousness in the right
hemisphere ? It is clear that the left hemisphere was cut ofif both
from knowledge of, and power of acting upon, the limbs of the
opposite side ; for although it was in full function, the patient was
unaware of her hemiplegia — the left hemisphere being so disinte-
grated as to be unconscious of it. And the example would seem to
show that one hemisphere can only act volitionally on the limbs of
the same side ; because though the left hemiplegia, granting it real,
vould account for the inability of the right hemisphere to act upon
the left side, it would not account for the entire unconsciousness of
the hemiplegia. And of course if the hemiplegia was not real, there
was no reason why the right hemisphere should not have been able
to act upon the limbs, except that it was cut off from communi-
cation. It is certainly an interesting question as to the extent of
power of one hemisphere over the limbs of the same side — whether
it has any direct consciousness and control of them, or only an
indirect power through its sympathy with the other hemisphere.
But it still remains unsettled whether there was actual paralysis or
not in Dr. Wilks^ case. If there was, what becomes of the assertion
that one hemisphere of the brain may carry on the intellectual and
bodily functions, without any apparent defect? On the other
hand, what difficulty is there in supposing that disease of the surface
only may produce paralysis, when we remember that disease or
laceration of the surface of the brain very frequently produces con-
vulsions ? The subject is evidently still wrapped in obscurity, and
demands patient clinical and pathological study.

Whatever may be the truth with regard to the sufficiency of
disease of the brain to produce paralysis, there can be no doubt that
such disease produces mental disorder. When it is acute, we have
delirium ending in coma ; when chronic, we witness a gradual failure
of intellectual power. The ultimate effect of a chronic change is, in
many instances, an atrophy : the brain becomes smaller ; the sulci
between the convolutions are filled with water, and the arachnoid
over them is thickened and opaque. The shrinking is partly com-
pensated by effusion into the ventricles, and the choroid plexus con-
tains cysts and earthy matter. This state of things is met with in
the atrophy of old age, of dementia, of alcoholismus, and of lead
poisoning; the decay of mental and physical power corresponding
in the main with the wasting of the brain.

After pointing out that the result of the retrograde changes which
occur in general paralysis is a destruction of the tissues and a corre-
sponding loss of function. Dr. Wilks puts the following questions to
alienists: — "Do they rely on the symptoms which accompany the
disease as characteristic of it ? or do they, on the contrary, consider
that the only cases which deserve the name of general paralysis are

54 Contributions to the Pathology of [April,

those in which they believe that there is an affection of the cine-
ritious substance, such as I have spoken of above ? Would such a
condition, in the absence of any of the usual symptoms, be sufficient
to constitute the disease ? Are a certain number of the symptoms
sufficient to mark it, even though one or two of those usually re-
garded as most characteristic should be absent P^^ He desires this
information, believing that much error ensues by reason of medical men
paying more attention to the study of one class of diseases than to
that of others ; and he gives the following happy illustration of the
truth of his remarks : —

I lately took the trouble to test the powers of diasnosis possessed hy
different physicians who pursued each his own speciality. A gentleman
came to me, as a patient, whom I recognised to he suffering from general
paralysis. He tottered or straddled into my study ; he spoke thickly, like a
man mtoxicated ; he had lost all intellectual expression ; he had tremor of
the tongue, and his pupils were unequal. He said he was very well, and
appeared cheerful. His reason for coming to see me was the fact that he
had had two or three hilious attacks. His wife, however, said that for many
months he had been forgetful and strange in his manner, so that he was
quite incapacitated for business. I afterwards met a medical practitioner
who had known him for years, and who was content to style the case one of
softening of the brain. It so happened that chance brought to my house
two gentlemen, one of whom had been making a study of Duchenne s para-
lysis, the ataxie hcomotrice (as it is called), while the other had been con-
nected with a lunatic asylum. The one, seeing my patient walk with a
tottering gait and with his eyes constantly directed towards his legs, was at
once impressed with his own idea of the case, and this notion was strengthened
when I showed him the inec^uality of the pupils, which, he said, is one of the
symptoms of Duchenne's disease. Some amount of reasoning on my part
was necessary to convince this gentleman that these characters are not
peculiar to his favorite malady. Mj other friend instantly recognised the
case as one of general paralysis, and expressed the opinion that the pro-
fession generally are very imperfectly acquainted with this disease.

This instance is, I think, sufficient to show that the true characters of the
different forms of chronic brain disease are not yet so accurately defined
that every one can at once distinguish between them. Many of the symptoms
at present described as peculiar to some are, in reality, common to many of
these affections, and are due to a general rather than to a special derange-
ment. It is said, for example, that general paralysis is cnaracterised oy
quivering li{)s and by hesitation in speech, followed by want of power in the
limbs ; that it often terminates in epilepsy, and that its mental symptoms
consist in a loss of control, in the existence of delusions, and, ultimately, in
a state of dementia. The ideas are generally of an exalted or ambitious
kind, but authorities state that the intellectual phenomena vary, and that,
whilst some patients are demented, others are maniacal. It is clear that
many of these symptoms belong simply to an atrophy of the brain, being
present even when this arises from alcoholismus ; hence, we must ask
whether the peculiar form of delusion, which is certainly one of the most
striking features in these cases, is sufficient to characterise the complaint,
and whether its absence is enough to negative the diagnosis of general
paralysis. Further, we must inquire whether a meningo-cerebritis, or some
other definite patholoscical change, is found after death in every case of this
disease. If a negative answer is given to the last question, then my friend

1867.] Nervous Diseases, 55

who called a case of general paralysis by the name of softening of the brain,
by which he meant a general decay of toe brain^ was not far wrong. I have
already sdid that if^ in a case of alcoholismus, we abstract the symptoms of
abdominal visceral disease, the nenrous symptoms remaining correspond
closely with those of general paralysis. I have also alluded to the so-called
** ataxic locomotrice," which is said to be a disease with characteristic symp-
toms ; but the condition of the pupils, and the presence of paralytic symptoms
affecting some of the cerebral nerves, show that the seat of tiiis malaciy lies
within the cranium, and not merely in the spinal cord. Hence, my col-
league. Dr. Gull, many years ago, alluded to such cases in his ' Gulstonian
Lectures * under the name of cerebral paralysis, and said that they were
brought about, not by any actual sofltenmg process in the spinal cord, but
by more general causes, such as sexual excesses.

I have said enough to show that, in studying the chronic affections of the
brain, we should endeavour to discover which symptoms are universal, and
which are proper to particular forms of disease. These complaints, as a
rule, can be distinguished by the circumstances attendant upon them ; it is
not difficult to determine whether the failure of bodily and mental power
arbes from poisoning by lead, mercury, or alcohol, from old age, or from
chronic inflammation.

The post-mortem appearances found in general paralysis are so far pecu-
liar that in this disease the brain is not suways obviously wasted, although
the normal tissue is really destroyed to the same extent as in atrophy.
Moreover, as this morbid change progresses slowly through the brain, and
does not affect it all at once, the symptoms of it may vary. Since it begins
in the cineritious surface, the mental powers oflen fail whilst much bodily
power remains. Thus, every lunatic asylum contains many patients suffer-
ing from this disorder who can walk well, and who enter into the games of
the institution, or are engaged in labour. That the guiding will may be
almost absent, although the motive powers connected with the central
ffanglia are perfect, is sometimes remarxably shown by cases of patients who
have considerable difficulty in starting, but who, when once the machinery
is set a going, will continue to walk until exhausted, having scarcely any
power to stop. Such a case is the very opposite of one in which, from dis-
ease of the centres or spine, all power is lost, though the mind and will are
mtact.

In the general paralysis of the insane, then, we find a chronic change in
the brain, and especially in the grey substance immediately beneath the
membranes. The inevitable result of such an affection is the gradual decay
of all bodily and mental power. By removing this morbid condition from
the category of special disorders we are not taking from its peculiarities,
but adding to its interest ; for if a spontaneous change of the kind mentioned
is productive of certain well-marked results, it is a point of ^reat pathological
and physiological importance to observe that like functions, induced by causes
of various kinds, she rise to very similar symptoms. This we see, for in-
stance, after injuries of the head and effusions of blood ; and, under these
circumstances, the post-mortem appearances also resemble what is seen in
the idiopathic form of disease ; indeed, it sometimes happens that the lesions
last named are the immediate exciting causes of a disease which is said to
be simply mental. Thus, I believe I am correct in asserting that, according
to the reports of asylums, evidence of hereditary influence fails in this dis-
ease more often than in any other class of affections seen in these institutions.
This is in favour of the view that general paralysis may affect a previously
good brain. If my memory serves me right, a history of hereditary pre-
disposition is wanting in a quarter of all cases of insanity.

56 Contributions to the Pathology of [April,

We should question the correctness of the statement that the
evidence of hereditary influence fails in general paralysis more often
than in other mental diseases ; indeed, we hold it more correct to
say that in a case of general paralysis, where there are no excesses
assignable as causes, there is almost sure to be some history of
hereditary taint. Dr. Wilks "regrets to find that in the reports
which are abundantly heaped upon us from lunatic asylums the work
of the mere secretary or superintendent so much overshadows that
of the physician, and that the scientific value of these pamphlets is
altogether sacrificed to their business character/^ He fails to find
in the reports in his possession any well-recorded cases with details
of post-mortem appearances, and he is fain therefore to adduce
examples from Calmeil. But there is an excuse for the scientific
baldness of those reports which Dr. Wilks has not thought of : they
are addressed to the Committee of Magistrates, and not to medical
men ; and they are intended as reports upon the condition of the
asylums during the year, not as scientific reports. While we bring
forward, however, this suflScient apology for the character of our
asylum reports, we are sorry not to have a word of apology to make
for the absence of scientific results commensurate with the import-
ance of the vast quantity of material collected in our numerous
asylums, and with the attainments of those who superintend them.
In this regard Dr. Wilks' complaint is only too well founded ; and
so far as it points to the isolation of the asylum physician from the
scientific spirit of his profession, by his absorption in economical
afiairs, it undoubtedly points to a real evil, and one which, unless
remedied, must inevitably, sooner or later, lead to many mischievous
consequences.

Epilepsy ; disease of the surface of the brain. — ^Dr. Wilks holds
the opinion that the morbid conditions of the brain which give rise
to epileptiform convulsions are remarkably uniform, and that they
all point to the presence of local irritation of the surface. He has
no hesitation in saying that for one case of disease in the pons
varolii with epilepsy, fifty cases may be found in which the morbid
changes occupy the surface ; and he cannot see any grounds for a
theory which supposes the seat of epilepsy to be in the pons or in
the central ganglia. " Disease of those parts would produce para-
lysis ; but in order to produce increased movements, they must be
healthy and susceptible of irritation. In the case of feigned
epilepsy we should say that the will, which is intimately associated
with the cineritious steucture, acts on the central ganglia beneath,
and excites them to the production of violent movements in the
limbs, exactly as in the real disease. Thus, we can believe that in
true epilepsy there arises in the superficial parts of the brain an
influence which is independent of the will, and, in fact, takes away

1867.] Nervous Diseases, 57

the consciousness by operating through the cineritious substance, and
which also irritates the ganglia below, and sets up the paroxysm.
At the same time we may allow that the pons varolii and medulla
oblongata are also excited, and we may thus explain the affection of
the respiratory nerves and of the spinal accessory^ which causes the
distortion of the head/^ In confirmation of these considerations
he points out that not only does irritation of the surface of the
brain usually produce convulsions, but that the most definite affec-
tion discovered in cases in which the symptoms have been undis-
tingoishable from epilepsy is an old adhesion of the membranes to
one spot on the surface of the brain. Furthermore, consciousness
is abolished during the epileptic fit, while the ultimate effect of the
disease, when it is long continued, is to produce imbecility. ''It appears
to me that, from clinical and post-mortem observations, as well as from
all analogy, wecannot but conclude that ihe/ons et origo mali is in the

cineritious substance of the brain So far as I know. Dr. Todd

has been the only author who insisted on the fact that the seat of epi-
lepsy is in the cerebral lobes ; but, if I remember rightly, this view
was not generally adopted at the time of its propagation on account
of objections based upon physiological grounds; nevertheless, it
appears to me that everything points to the correctness of this
opinion. I am myself so convinced of it as to feel sure that the
improved method of examination used by Mr. Lockhart Clarke will
show a well-marked change in the cineritious substance of the
brain in cases of long-standing epilepsy.'' Dr. Wilks gives the
outlines of a few cases which support these views. And we might
call to mind, as an additional argument in their favour, those in-
stances of periodical maniacal excitement which really represent a
vicarious epilepsy — the cases in which mental convulsions take the
place of the usual bodily convulsions.

Tumours productive of mania. — In the few recorded cases of
tumour giving rise to mania. Dr. Wilks finds that the tumour has
always been of the cholesteatomous kind ; and he beheves that this
affords ground for thinking that the disease may have been merely
coincident with some other undiscovered change more immediately
connected with the altered mental state of the patient. We feel
loth, however, to admit this conjecture on the basis alleged for it ;
for, in the first place, there are cases on record in which the tumour
producing mental derangement has been cancerous or fibrous, or
tubercular, or syphihtic, or a cysticersus ; and, in the second place,
it is easily conceivable that in the case in which a tumour does cause
mental disorder, it may do so by a reflex or sympathetic action hke
that by which an abscess of the brain may disturb, or abohsh for a
time, the patient's intellectual functions, though at another time not
affecting them observably.

58 Contributions to the Fathology of Nervous Diseases. [April,

Disease of the cerebellum, — ^The theory that the function of the
cerebellum is to harmonise and co-ordinate the various movements,
is not supported by a single clinical fact, so far as Dr. Wilks is
aware. We rejoice to have so authoritative a statement, for we have
always been of opinion that it never was supported by a single
physiological fact, or by a single well-considered reflection. How
it has been possible for writers to go on assigning such a function to
the cerebellum at one part of their books, and at another part to de-
scribe the independent function of the spinal cord as ministering to
automatic acts, primary and secondary, is not easy to explain. In
none of the cases of disease of the cerebellum which have come
under Dr. Wilks* care, has there been observed anything more than
a desire to lie quiet in bed, and an anxiety to be let alone — symptoms
which are common in other cerebral diseases.

But enough has been said to indicate the character and the im-
portance of Dr. Wilks's contributions to the pathology of nervous
diseases : they must be studied by all who desire to learn what is
known of this obscure subject, and what are the most promising
lines of further investigation. If we were disposed to venture any
criticism of them here, it would merely take the expression of a regret
that Dr. Wilks has not considered it within the scope of his paper
to give an exposition and criticism of the views of other observers,
EngUsh and foreign, but has contented himself with the modest
enunciation of the results of his own observations and reflections.
In the confusion of dubious observations, uncertain inferences, and
contradictory theories with which the pathology of nervous diseases
is beset, the ripe criticism of so competent an authority, eliminating
what was worthless, and co-ordinating the real work done, would
have been a welcome and invaluable guide to those who, each moving
in a different way, are all now in wandering mazes lost. We would
fain have added —

Henceforth thou art the genitis of the shore.
In thy large recompense, and shalt be good
To all that wander in that perilous flood.

H. M.

1867.] 59

CLINICAL CASES.

Acu^ Mania and Acute Maniacal Delirium.
By Hbney Maudslbt, M.D. Lond.

In the unfortunate but unavoidable absence of a medico-legal
report, which was to have occupied this part of the Journal, the
following two cases may find a place. They are selected from my
work on the ' Physiology and Pathology of the Mind/ and they
serve to illustrate the difference between the ordinary acute mania
which we often have to deal with, and that acute maniacal delirium
which occasionally comes under treatment. The distinction is of con-
siderable importance ; for, while in acute mania it would be proper
and beneficial to insist upon abundant exercise in the open air, by
making the patient walk about between two attendants, if necessary,
such practice would be most unscientific in acute delirium, and very
likely to be followed by fatal consequences. It would be better to
place a patient suffering from such acute degeneration of cerebral
function entirely in seclusion, thus giving him the chance of, what
he most of all needs, rest, than to aggravate his disorder by forced
exercise and mischievous struggles with attendants. The prognosis is
never very favorable in acute delirium, but it is very mucn influenced
for good or evil, according as food is taken by the patient or not.

Case. — ^W. P — was a merchant, of great originality of thought and energy
of character, who became insane, after making a considerable fortune en-
tirely by his own abilities. His mother had died insane. Afler slight depres-
sion, and certain transactions in business, which rather astonished his friends
as being opposed to his usual manner of doing thines, he broke out into
eccentricities and extravagances of behaviour, with which was associated an
unaccustomed liveliness ; m fact, he acted very much as if he were intoxi-
cated, turning certain pictures with their faces to the wall, putting chairs in
queer positions, walking about the garden bareheaded and singmg ; alto-
gether he appeared joyous, and was eccentrically industrious. If spoken
with, he was lively, wittv, original, and satirical, laughing with a laugh of
peciUiar harsh and metallic ring, which he could not have imitated when in
nealth : still he could control himself for a time, and speak with a marvel-
lous assumption of calmness if he pleased. There was so far no positive
insanity of thought, though there was great insanity of action ; his condi-
tion might be said to represent an acute form of that stage of disease which
has been described as the mildest form of hereditary insanity. Degenera-
tion proceeding, however, he became in a day or two much worse : he raved
incoherently in conversation, was violent in action, and not amenable to con-
trol ; his language was obscene and disgusting, his behaviour not less so ;
and he represented very completely the condition of a furious maniac, whose

60 Clinical Cases, [April,

habits were of the filthiest kind ; he masturbated with frenzied energy, and
eagerly licked up the secretion, swallowed his urine, and painted nimself
with his faeces, chanting a wild chant the while, or talking in rapid incohe-
rence. In all this extremity of fury, however, there were plainly evinced
on his part a certain consciousness of his extravagances and a capability of
modifying Lis actions in certain regards, which could not fail to give his
conduct the semblance of wilful denance and witting offence to the feelings
and opinions of those who had to do with him. As the energy of this stage
somewhat subsided, various delusions — as that he was made the victim of
medical experiments by night and by day, but especially by night — were ex-
hibited; the strange disease-produced feelinofs, nowise conforming to the
order of his previous experience, and the feeling of the automatic agent of
acts not his own which he was made by disease, were interpreted as the
results of external malicious agencies, as they were plainly not within the
domain of his conscious life and voluntary control. This condition of
things lasted for more than a week, af)er which, as the maniacal fury and
delusions disappeared, there ensued a state of the profoundest moral disturb-
ance. He was possessed with a great hatred to all those who were especially
his friends ; was sullen, morose, and gloomy ; represented, in the unfairest
way, everything which had been done to control him — and he had an excel-
lent memory of what had been done — as a violent cruelty ; misrepresented
any kindness or act of attention from his relatives ; refused his food or took
it most capriciously ; and, although all positive delusions seemed to have
vanished, yet he appeared to lo(^ upon others as responsible for all his
sufferings and extravagances. One might reason with him, but even if he
acknowledged the justice of the arguments, which he sometimes did, it was
a hypocritical affectation ; for to another he would immediately afterwards
set forth his unparalleled grievances in the most perverse and untrue manner
— more untrue because he so completelv twisted and perverted some little
truth. When well be had always displayed a scrupulous regard for truth.
There was no intellectual incoherence, but marvellous ingenuity : he could
assume such an appearance of calmness and logical moderation in his com-
plaints, accusations, and statements as would deceive the very elect. And
be actually succeeded in imposing upon an influential friend, who, himself a
most honorable man, was so much influenced by the calmness and coherence
of his stories, and by the plausible way in which he accounted for all his
peculiarities, as consequences of the position in which he was placed, or
slurred them over, that he represented in the strongest possible manner to
his immediate relatives the injustice of keeping him longer under any sort
of restraint. Accordingly, in this condition or imperfect convalescenee, of
unquestionable extreme moral or affective insanity, and in opposition to
medical remonstrances, the patient was freed from all restraint: all the
people in his neighbourhood thinking that he had been most unjustly con-
fined. The consequence was, that in the course of a few weeks he had so
managed, or rather mismanaged, his property — selling stock at great loss, and
giving away large sums of money under the most singular pretences — as to
afford an excellent harvest to the lawyers, and greatly to impoverish his
children. It was found absolutely necessary to placenim under restraint again,
where he will remain, doubtless, for the rest of his life. For, although he was
apparently quite rational for three or four weeks at a time, yet the attacks
of mania constantly recurred, gradually becoming more prolonged, and the
intervals of sanity less, until the disease acquired the character of de-
mentia.

In this case we may observe that the first stage of the degenera-
tion was a short period of unquiet and of unaccountable depression,

1867.] Clinical Cases. 61

which Guislain believed to occur in the great majority of instances,
and which not unfrequently precedes an ordinary fever or other
grave disease : it is, as it were, the projected shadow that portends a
great calamity, the foreshadowing gloom or painful forefeeKng of
the coming storm. Afterwards there quickly followed a stage of so-
called exaltation, in which the patient seemed to be in an exube-
rantly happy state, as though transported with some joyful tidings,
and perpetrated various extravagances of speech and action as though
from an overflow of life. Some have not hesitated to describe this
condition as one of increased mental activity ; even Schroeder van
der Kolk has fallen into what we cannot but consider this great
error. The real state of the patient is one of irritable weakness : he
is unduly impressible, abnormally excitable, and reacts in sudden
impulses of feehng, thought, speech, and action, which more resenible
spasms than anything else; he is entirely incapacitated from the
calm reception and discrimination of impressions, the subsequent
quiet reflection, and final intelligent act of volition — the complete
co-ordination of mental action, which is implied in the highest
mental activity ; his words and actions are like the idiot^s tale, " full
of sound and fury, but signifying nothing/' The condition of
nerve element, which is the basis of this excitabihty, is a reaction
after the preceding depression, and it marks the commencement of a
degeneration which, if not checked, will go on to the further stage
of positive maniacal degeneration of mental action, hke as the reac-
tion of other kinds of organic element that have been chemically or
mechanically injured passes into inflammation and purulent degene-
ration : it is a state of instability of composition corresponding with
that which is the condition of the mildest forms of hereditary in-
sanity, where very striking exhibitions of particular talents some-
times occur.

Striking in this case was, what is often observable in other cases,
the metallic ring of the strangely altered voice. This maniacal
change in the tone of voice, which is apt to grate so harshly on the
sensibilities of those unaccustomed to hear it, testifies not less surely
than the deranged thought, perverted sensibility, and furious con-
duct to the profound and general disturbance of the nervous system.
" When a man is a lunatic,'' says Dr. Bucknill, ''he is a lunatic to
his fingers' ends :'' he is aUenated from himself both bodily and
mentally. I cannot help making the remark here, that in almost
every msease, but especially in insanity, there are a great many
unobtrusive symptoms in which nature speaks that are almost en-
tirely overlooked, attention being so much fixed on a few prominent
symptoms. In insanity, for example, there is not only the changed
tone of the voice, but there are peculiarities in the expression of the
countenance, in the look of tne eye, in the posture of the body :
these constitute the physiognomy of the disease, and deserve the

62 Clinical Cases. [April,

most exact study. I think it not impossible in many cases to deter-
mine from such signs not only whether the patient is suicidal, but in
what degree he is suicidal — ^whether at any rate there is a desperate
impulse that, like an evil fate, governs the patient and waits and
watches for opportunities, or whether a fluctuating impulse is excited
to activity by opportunities. Again, there are great diversities in
the character of what we confound under the general name of pain,
as well as in the character of those manifold modifications of sensi-
bility which fall short of pain, all which have their specific meanings
had we but the knowledge to interpret them. Two circumstances,
noteworthy in many cases of insanity, were marked in the case
under consideration : these were the peculiar indescribable odour of
the patient — the bouquet des malades of lunatic wards — and the
intensely offensive character of the intestinal excretions. Manifestly
there is some unknown chemical change produced in the excretory
functions by the profound nervous disturbance, not otherwise than
as secretions are observably altered in composition by passion ; and
the result attests, like other effects just mentioned, the essential
interaction of the mental life in the whole bodily life, and the impos-
sibility of separating, save in thought, mental and bodily phenomena.
It behoves us therefore to carry with us to the investigation of any
case of insanity a deep sense of the importance of scrupulously stu-
dying every sign of physical disturbance, motor, sensory, or nutri-
tive, as well as the prominent mental symptoms.

The third stage or degeneration exhibited by the patient was that of
acute maniacal fury, of which it is not necessary to say more than to
point attention to the evidence of the persistence of a certain amount
of self-consciousness, and the occasional manifestation of a certain

Eower of self-control for a moment. This is the more necessary
ecause of the foolish criterion of responsibility sanctioned by English
law, or rather by English lawyers. Certainly this patient, at all but
his very worst moments, and perhaps even then, was conscious of
what he was doing at the time, as he had an exact and complete
memory of it afterwards, and was quite aware that it was disgusting
and offensive to those around him ; he had even some power of self-
control at times, as he would not do before me what he would do
before attendants ; so that if the legal criterion of responsibility had
been strictly applied to his actions, this man, suffering the extremity
of maniacal disease, would not have escaped punishment. As the
maniacal fury subsided and delusions appeared, the disease becoming
more chronic, we might say that a fourth chronic stage was passed
through — a stage characterised by the persistence of ideational dis-
order, that is, not only of morbid ideas but of the morbid associa-
tion of ideas, after excitement of conduct had ceased. From this the
patient soon passed into the fifth, well-marked stage of affective in-
sanity, a condition which usually lasts for some time after ideational

1867.] Clinical Cases. 63

disturbance has disappeared. The result of his premature removal,
while so suffering, affords an excellent illustration of the truth
of the observation of Esquirol, that the disappearance of hal-
lucination or delusion is only a certain sign of convalescence when
the patients return to their natural and original affections. At the
earher period of the disease there succeeded to this stage an interval
of apparently perfect sanity before the supervention of a new attack,
bat as time went on this interval became less evident, and at last
was omitted altogether ; so that, instead of a recurrent mania, there
was a continued mania established, with regular stages of exacerba-
tion and decline, and a steady declension towards the last stage of
all, that of dementia, took place.

Now if we choose to suppose, as we might not unfairly do, each
of the stages of disease gone through by this patient to exist in
some individual, and to constitute his permanent state — ^if we con-
ceive, in fact, the progress of degeneration through generations in-
stead of through the individual Ufe — ^then we may form a tolerably
correct idea of the varying forms of general ideational insanity that
are met with. In one person the fury of action may be most
marked ; in another, the delirium of thought, chronic or acute ; and
in a third there is a predominance of the affective disorder. If we
eliminate the element time in considering the course of mental dis-
ease, and do not suffer our thoughts to be constrained by it, we may
certainly be enabled to get more correct views of the relations which
the different forms bear to one another; the events of generations
and of the individual life are brought together within the same com-
pass of time, and pass in procession before the imagination, as it
were, on the same theatre : a morbid stage, which might scarcely be
noticed or might be entirely passed over on account of its rapidity
and briefiiess in the individual, will be distinctly evolved in the pro-
gress extending through generations ; and a phase of disease which
might have an exaggerated importance or an independent character
assigned to it in the generation will receive its right interpretation
by a consideration of the course of the disease in the individual.
Had this principle been at all times clearlv apprehended, it may be
justly questioned whether any one would have been found to doubt
or misinterpret those obscurer forms of mental disease that have
been the cause of scJ much unprofitable contention and angry
feeling.

A form of most acute mania, which runs a rapid course, deserves
particular attention, both on account of the rapidity of its course,
the gravity of the prognosis, and the special treatment demanded.
It is really an acute maniacal delirium rather than a systematised
mania, the d^ire aigm of French authors, and is characterised by
great excitement, entire incoherence, apparent unconsciousness of
what is going on around, and extreme restlessness ; the course of

64 Clinical Cases. [April,

the disease being swift either to recovery or to death. The follow-
ing example will serve to illustrate it : — A cook in a gentleman^s
family, whose age was not known, though plainly between forty and
fifty, was rather suddenly attacked with acute mania. Nothing was
known of her previous history, but she had been considered by her
fellow-servants to be a little peculiar, and she had suflFered from a
chronic erysipelatous inflammation of one leg, which had disappeared
a short time before her attack of insanity. She had been ill seven
days when admitted into the hospital, and during the whole of that
time had been noisy, violent, and utterly incoherent ; and she had
taken no food for several days. On admission, her state was one of
the extremest maniacal excitement; she was noisily incoherent,
stripped ofif her clothes, rolled on the floor, was unconscious of the
calls of nature, and seemingly unconscious also of what was said
or done to her; she was continually spitting frothy and sticky
saliva, and the look of her countenance was horrible and heart-
rending. She could not be got to take food, and it was with the
greatest difiiculty that beef-tea, eggs, and brandy were administered
to her at frequent intervals. Morphia made her sick, and did not
make her sleep. This went on night and day for a week, when she
was reported to have become quiet ; but it was the quiet of com-
plete exhaustion. Her pulse was so feeble and rapid that it could
not be counted, though up to the moment of the collapse she had
been as excited, as noisy, as restless as ever, and she still rolled on
the floor, tossing her arms about and pulling at her clothes. Next
day the heart beat feebly 160 times in a minute, as far as could be
made out where no exact examination was possible, and with a
certain undulatory action which raised the suspicion of pericarditis ;
but there was no increase of cardiac dulness. The skin was hot and
dry ; there was extreme jactitation ; and she drank fluids eagerly, as
she had never done before. I thought there was some abdominal
tenderness on pressure, but could not be sure of it. Next day she
was clearly sinking fast, and muttered words which so far could be
made out were a request for holy water ; she was a fioman Catholic.
Pressure on the abdomen now produced evident shrinking. On the
following day she died. On examination of the body after death,
the pericardium, when opened, was found not to contain a drop of
fluid; its surface was dry, rough, and markedly injected, and its
substance seemingly thickened generally, and certainly so in parts
by oblong patches of lymph of old standing. There were similar
layers of lymph on the heart, the substance of which was pale and
flabby, and its cavities were full of blood, mostly uncoagulated.
The intestines were almost universally of a rosy red hue, which on
closer inspection was seen to be due to injected vessels. The arach-
noid was slightly clouded, like glass gently breathed upon, and
streaked with a delicate milky opacity along the lines of the vessels.

1867.] On, the Treatment of Destructive Patients. 65

whfle it was bulged at the sulci by a cleaif serous fliiid beneath^
The ventricles were filled with a similar fluid, which existed also in
considerable quantity at the base of the brain. • On slicing the
brain numerous red spots were visible, and when the surface of the
cerebellum was exposed it was seen to be strongly injected in beau-
tiful arborescent fashion. Had the examination been carried fur-
ther into the minute structure by a competent microscopist, I doubt
not that the ideational cells of the cortical layers would have been
found to be clouded and troubled like as the arachnoid was. The
yisible morbid appearances at any rate were instructive and inter-
esting, and afibrded some compensation for the painful feeling of
utter helplessness which one had had in face of the disease during
life. An obvious speculation as to the cause of the disease could
not fail to present itself: that an erysipelas disappearing from the
surface of the body had selected for attack the arachnoid and other
serous membranes. Though the issue was fatal in this case, it is
not so in all cases of acute maniacal delirium ; it is, however, a
disease which should unquestionably be regarded seriously, both on
account of its occasional intractability, and on account of the
suddenness with which fatal exhaustion may supervene.^^

tke !Preatment of a certain class of Destructive Patients, By
Edgar Shbpp^d, M.D., Medical Superintendent of the Male
Department of Colney Hatch Asylum.*

Incidents occasionally arise in the management of great asylums,
which lead us to reflect how little the community at large are aware
of the state to which a human being may be reduced by what we
term insanity. We learn, too, how exacting, unreasonable, and
uncharitable the outside world may become, in reference to the
unavoidable condition of some who seek the shelter of those hos-
pitals to which our specialty devotes itself.

It is within the experience of every medical superintendent how
prone are the firiends of patients to assume that ill-treatment and
neglect are the order of the day. If a bruise shows itself upon a
feeble and helpless lunatic, some attendant caused it. If a scratch
is seen upon the face of one who is violent and aggressive, it is -the
work of some asylum oflBcer. Bruises and scratches, quarrellings
and fightings, personal encounters, seditious melees, are unknown in
the big world without. There the leopard lies down with the kid,
and a little child leads them. Why does not this happy state of

• Thongh dissenting ourselves from the opinions expressed "by Dr. Sheppard
in this paper, we trost that his appeal may elicit from some of our members the
resnltfl of their great experience in the treatment of a very troublesome class of
patients. — Ed.

VOL. xin.* 5

66 On tke Treatment of Destructive Patients; [April,

things obtain in lunatic asylums ? It does not occur to the public
mind that the patients we receive are brought to us because of their
violence, because of their feebleness and consequent liability to injure
themselves, because of their epileptic fits or other affections which
render them particularly prone to the infliction upon others or to the
reception in their own persons of external bruises or internal injuries.
To suppose that any sort of supervision, however vigilant, can

{protect patients of this kind from every chance of accidents, is to
ay a most unreasonable exaction upon our superintendentship, and
require a state of discipline which can never be attained. Con-
sidering the increased tendency of the maniacal to violence, of the
paralysed to feebleness and unsteadiness of gait, of the epileptic to
unavoidable wounds, it would be a matter of surprise to any reflecting
and observant person if the results of such tendency could any-
where successfully and entirely be prevented. That they should be
prevented in a large measure is certain ; that they are prevented in
a large measure is not less true. The elaborate machinery set at
work in asylums is for this purpose. But machinery is not so per-
fect anywhere as to yield us no list of casualties, in spite of all our
eflPorts to render it so.

It may be instructive to illustrate this position by actual expe-
rience.

Three years ago a patient was admitted into a large asylum, bliud,
paralysed, feeble, and greatly impaired in health. He was the sub-
ject of various delusions, and imagined that persons were pursuing
him and trying to murder him. At night, in his fears and anxiety
to escape his pursuers, he would keep trying to climb up the sides
of the padded room in which he was placed for self-protection.
After hours of ceaseless rubbing and clawing, he at last managed to
get some kind of purchase for one foot, by which he was enabled to
raise himself a considerable height towards a shuttered window. He
slipped, however, and fell, bruising his nose and face considerably.
This was at 2 o'clock in the morning. The medical superintendent
was passing at the time, and hearing the fall, coupled with a loud
cry of ''murder,'' he opened the door, and found the patient
bleeding at the nose, and crying for mercy. At 10 a.m. the
patient's face was much swollen, and his eyes were discoloured. At
11 o'clock his wife saw him, it being one of the visiting days of the
asylum. The patient told her that persons had been murdering him
in the night ; and the wife, horrified at his appearance, believed he had
been brutally treated by the '' keepers." It was with great diffi-
culty that she was quieted, and led to credit in some maimer th&
statement of the medical superintendent as to the cause of her hus-
band's appearance. If this man had died within a few days, the wife
would probably have demanded a coroner's inquest, and it would
have been hard, looking at the personal disfiguration of the deceased^

1867.] hy Db. Edgar Shbppard. 67

and knowing the tendency of common-place minds suddenly charged
with official dignity and responsibility^ to assume prima facie Tio«
knoe^ to convince a jury that deatk had not been caused^ or at least
hastened^ by unfair usage.

Three days ago> in the same asylum^ a patient was admitted
paralysed and impaired^ but supposed by his friends to be in good
health. The night of his admission he had an epileptiform seizure^
threw himself about in the padded room^ and Dlackened both his
eyes. If his friends should see him before he has resumed his
natural appearance they will probably believe the man has been
ill-used. If he should die suddenly (which is not improbable)
before they see him, and before the bruises have disappeared, the
matter will be still worse. No one saw the bruises inflicted, but to
the eye of the medical superintendent there is evidence of a convul-
sion, during which they were unconsciously self-inflicted. If a
coroner's jury is summoned they will probably share the suspicion
and the indignation of the deceased's friends ; and instead of " well
and truly trying'' the issue, they will prejudge it, constitute them-
selves the partisans of a supposed injured man, and in the absence
of direct proof that death was caused by violence, append some qua-
Kfying and offensive remarks to their official finding of " Natural
death."

These are typical and very instructive cases. At the hands, or
tather in the minds and by the tongues, of all they receive a conven-
tional treatment. Sympathy is manifested where it is not called for,
and injustice is reiidered where it is not deserved. It is of great
importance, therefore, to bring such instances under the notice of the
puolic, that they may be led to see, if possible, the liability of
innocent persons to have guilt imputed to them, or, at all events, to
be spoken about most uncharitably.

Being more helpless and less responsible than any other members
of society, it is indeed no more than right that lunatics should have
every sort of protection. That they are now largely protected is
beyond a doubt, and that most cases of cruelty and neglect are
brought to light is beyond a question. Nay, so widely are they
shidlded by the unrestricted humanities of modem treatment, by the
supervisorship of commissioners, of magistrates, of guardians of the
poor> and by the censorship of the press, that they are the most pri-
vileged subjects in the British dominions. Moreover, there is
superadded to all this a yet securer protection, based upon the
acquired knowledge on the part of those who have charge of them,
that the ratio both of good discipline and of cure is the measure of
kindness and judicious handling exercised towards the insane.

And yet the startling incidents which sometimes occur lead us to
aak, if all these privileges and protections are not sometimes ensured
at the expense of justice to those sane persons who have cast tipon

tS On the Treatment of Destructive Patients ; [Aprif,

them the responsibilitj of asylam administration. Is it not true
that in every inquiry touching the general treatment of the insane
the case is at once invested with suspicion by those whose duty it is
to make such inquiry? Is there not a liability to prejudge the
motives and the acts which have brought about any particular in-
vestigation ? Is there not an inaptitude in the pubhc mind, overfed
by, and yet still craving for, the " sensational,'' to deliberate calmly
upon doubtful circumstances, and reflect dispassionately upon
matters which have the faintest semblance of wrong ?

It may be doubted whether the pubKc are so much to blame as
the -press, which often creates a morbid taste, ministers to it, and
supplies it with baneful exaggeratidns. In the eager anxiety to
anticipate his contemporaries — to be the first at promulgating a bit
of "startling intelligence'* — a journalist grasps at an ex parte
statement, rattles oflp upon it a leading article, in which he over-
colours all the facts which, if in fairness he would only wait, will be
toned down, and have given to them a different complexion, by the
audi alteram partem of to-morrow. What is justice to him ? He
has an expectant crowd waiting for his news and his lucubrations,
and he cannot afford to postpone a sensational narrative and a
slashing commentary upon it, which will increase the immediate sale
of his paper, merely upon such very common pleas as those of truth
and honesty.

In the large asylum from whose records the above-mentioned
cases have been drawn, a circumstance has recently occurred which
illustrates the taste and the tendency we are now discussing.

In the spring of 1866 some person (supposed to be an attendant
discharged for dishonesty and ill-treatment of patients) wrote a
letter to the Commissioners in Lunacy, complaining of the cruel
treatment of the male patients in Colney Hatch Asylum — ^particu-
larising two by name. It was stated that one named Harrison had
been put into a room without any bedding or clothing for ten suc-
cessive nights ; and that another, named Hobbs, had been so im-
mured for 140 nights in succession during the winter of 1864-5.
Upon receiving this communication the Commissioners requested the
medical superintendent of the male department to attend a meeting
of their Board, which he did, and where he pointed out the inac-
curacies and exaggerations of the charge, but admitted that for
several nights these two patients had l^en in their rooms without
bedding or clothing, in consequence of a persistent destructiveness,
which there was no possibility of controlling but by the substitution
of restraint — a measure of which he did not approve. The maximum
of Hobbs' confinement in a nude state was four nights instead of
140, his residence in the asylum having only been sixty-seven days*
Nor did the maximum of Harrison's similar confinement exceed four
flights, at long intervals.

1867.] hy Dr. Edgar Shbppard. 69

Yet in spite of this clear and explicit statement, to be read in the
Asylum Eeport, all the newspapers have put forth the untruthful
declaration of the complainant (whose animus is unmistakeable) as
the real narrative of facts, and have grounded their remarks there-
upon. Even one of the medical journals, in a spirit of recklessness
which it is difficult to characterise in proper terms, has similarly
misrepresented all the circumstances of the case, and written : '^ The
statement made by Mr. Pownall, and admitted to be true by Dr-
Sheppard, medical superintendent of the Colney Hatch Asylum, was
to the effect that a patient named Harrison was put into a room
upon bare boards, within brick walls, without either clothes or bed-
ding ; that Hobbs, another patient, was similarly immured for 140
nights during the winter,^^ &c.

How difficult it is, you see, even for those who lay claim to the
scientific conduct of a medical journal, to resist this tendency to
overstatement, where such overstatement runs into the '^ sensational,"
To me it seems that unless a periodical is accurate in its reports,
and careful about going to the fountain-head for its information,
before it commits itself to the responsibility of censorship, it sinks
itself to the level of those cheap newspapers whose chief duty seems
to lie in pandering to the public taste for Lady Audley^s and other
such-like " secrets,'' To assume a certain position taken by another
to be false — to hurl invectives at its indefensibility — to say that
motives are beside the question, and to show by remarks that facts
are beside the question likewise — ^these things are not calculated to
elevate the science which we try to elucidate, or to make manifest
that love for impartiality which should be held sacred by every
writer.

Let me now enter upon the use of the first personal pronoun, and
make a few observations in my capacity of medical superintendent
of a large asylum, upon the general management of a certain class
of destructive patients. If I advance anything new or startling, I
do so in the interests of humanity, and with a view of ameliorating
the condition of those in whom I am interested, and among whom
I spend my time and my energies. Tor what I have to say I invite
the careful consideration of other superintendents, and the judicial
weighing of educated men, having in view the same object as myself.

Some drift of the position which I desire to take may be gathered
from an extract of a letter published in our Annual Eeport, addressed
by me to the visiting justices on the subject of the two cases above
referred to.

'' I have already explained to you (the visiting justices of the
asylum), by word of mouth, that the patients in whom the destruc-
tive propensity usually manifests itself are, for the most part, of the
elass termed general paralytics ; that their physical sensations and
perceptions are impaired or annihilated ; that they besmear them-

70 On the Treatment of Deitruotive PatimUe; £Afri^

selves with their own filth ; that their skins are of an minaturallj
high temperature ; that their delusions are of the grand and extrava-
gant kind ; that they will stand or sit the whole of the night naked,
with their bedding and clothes heaped in one comer of the room,
singing, laughing, gesticulating, and giving every evidence of their
own Imppiness. The only thing which robs them of their pleasur-
able sensations is restraint. Ijiis is why I do not practise it. I
have gloved a patient at night to prevent destructiv^iess, but the
result has never been satisfactory. The wrists have been galled by
the ceaseless efforts of the patient to free himself, and if he has not
destroyed his rugs, he has not used them. The lunatics of an earlier
day were chained and manacled — not so much for their violence as
their destructiveness. They had straw to lie upon ; and I believe
that the playing with the straw was to them a source of infinite
amusement — better for them to spend their uncontrollable enei^es
upon than strong rugs and ticken frocks.

'^ The question, then, really is — How are these cases of destruc-
tiveness to be managed ? The worst subjects of this propensity will
destroy padded rooms ; shirts and blankets and strong rugs they rip
to shreds, and have only their full measure of satisfaction when they
have reduced themselves to a state of complete nudity. To gag the
mouth, to fasten down the arms, to glove the hands, is at once to
distress the patient, and substitute a restraint which is intensely
irritating for a freedom which, though seeming to result in a state
of things which shocks philanthropy, involves no sort of unhappiness
or suft'ering. This is a conviction which has been forced upon my
mind by visiting patients of the kind described at all hours of the
night, and conversing with them upon those imaginary pleasures
with which their minds are occupied, and by which they are happily
blinded to a sense of their own physical degradation. And thiB is
why I have occasionally sanctioned the withdrawal from a patient of
his bedding and clothiug at one of those periods when his destruc-
tiveness has reached its highest point. I have been unwilling to
see the county property destroyed night after night, for no sort of
purpose.

'' In the interview which I had with the Commissioners in Lunacy
on the 18th of June, I invited them to give me some suggestions as
to the manner of treating such cases as those now under conside-
ration. They say that for patients to be in rooms without bedding
or clothing is unheard of in this philanthropic age, and that such cir-
cumstances admit of no sort of justification. But it must be known
to any commissioner who has been a superintendent of an asylum
of any magnitude, that numberless patients are uncovered the whole
night— that they will stand up naked or lie upon the bare floor,
having heaped their bedding and clothing into one eomer oi the
room, or amused themselves by tearing it to pieces. Thff cxm-

1867.] ly Dr. Edoae Sheppaed. 71

dition for themselves, unconsciously, the very surroundings of only
seeming discomfort, which have been very rarely and exceptionally
ordered in cases of extreme destructiveness. The two states are
absolutely identical.''

It should be observed that there are two classes of destructive
patients. In one there is a state of dermal ansesthesia — diminished,
almost annihilated, sensibility — ^with little or no elevation of tempe-
ratmre. The sense of taste here is also not infrequently destroyed
or perverted, as evidenced by patients besmearing themselves with
and eating their own excrement. In another class there is heightened
sensibility — dermal hypersesthesia — with great elevation of tempe-
rature. In these cases the skin continuously exposed in a room of
ordinary or even low temperature retains its elevation.

Experience leads me to the belief that there is a mode of treat-
ment—of a passive but not on that account of an unadaptive kind—
specially suited for these perplexing cases. Alluding to this mode,
a writer in the ' Medical Times and Gazette' of this week says it
was ''probably humane, certainly not cruel or unjust. It would
have been vastly more cruel to have increased the sufferings of the
poor patients by covering them forcibly with clothing which their
instincts rejected, and by the adoption of the only possible means of
retaining it upon them, namely, bodily restraint. How often does
each of ourselves, sane though we be, when restless and hot at
night, thro'w off every article of clothing, except a night-shirt, before
we attain the sensation of comfort essential to sleep ! How many
of' us have not been guilty even of walking about our rooms naked
as we came into the world, in order to attain the same object ? Is
a lunatic not to be permitted a similar gratification of a harmless,
perhaps beneficial instinct ?"

This question exactly expresses the truth and common-sense of
this question. Wherever there is a hot hypersesthetic skin, clothing
of any kind is a distressing burden, and self-created nudity is the
result, as being alone supportable. We have evidence of this even
in recent cases of acute mania.

Eighteen months ago, I admitted into this asylum a young man,
well educated and in prosperous circumstances, suffering from a
severe attack of acute maniacal excitement. He was brought here
in a strait-jacket, having been very violent and threatening. He
bad a warm bath immediately, with a cold douche to the head, and
then took one drachm and a half of Battley's sedative in a pint of
beef-tea. He was placed in a padded room, with a shirt on, a
mattrass on the floor, and ordinary clothing. He continued very
noisy, and could be heard jumping about the room, and shouting to
the Almighty to deliver him from the flames of hell (a not un-
common supplication where there is a hot hyperaesthetic skin).
Upon opening the door, .after the lapse of one hour, it was found

■ -

72 On the Treatment of Beztructive Patients ; [April,

that he had torn his shirt to shreds^ and heaped his bedding into
one corner. His skin was intensely hot and burning, and he was in
a state of great excitement. The bedding and clothing were now
withdrawii, and a strong ticken shirt, fastening by lock at the back
of the neck, was placed upon the patient. In another half hour he
had nearly strangled himself in his efforts to draw the shirt over his
head. This was now removed likewise, and he was left in a state of
nudity. To him the world was not large enough for freedom, and
the slightest hindrance to his movements by the contact of clothing
was restraint. Three hours later this man was asleep, the first time
for more than a week, his friends said, and he did not wake up for
five hours. For several days he was in the padded room, but he
refused to have any clothing. With his improvement, which began
on the fourth day, the temperature and hypersesthesia of skin di-
minished, and he had ordinary bedding and clothing. He made a
rapid recovery, and left the asylum, expressing his gratitude for the
kindness he had received from every one. I remember his speaking
to me during his convalescence of his being naked, of the great
relief it was to him, and of the terrible insupportableness of his
clothes. I have seen cases of this kind over and over again. They
are full of interest to those who will suffer themselves to be taught.

Now, if this patient had been seen sleeping in a state of nudity by
his friends, or by any clamorous outside humanitarian, this passive
treatment would not only have been called in question, but severely
censured. We could not have convinced them that this nudity was
the very condition which first ensured the sufferer's sleep.

If the perfection of treatment, however, is manifested by its
adaptiveness, and by the relief which it affords to the patient, as
evidenced by its immediate results, and by his subsequent confession,
surely he is a bold man who will question its theoretical and prac-
tical soundness. Yet this is not the principle acted upon by those
who write with fine pens, in slippers and dressing-gown, that for a
lunatic to be naked is barbarous, and that the permission — the
oflBcial countenance — of such a thing is '^inconsistent with the
modern and more enlightened system of treating mental disease.^'

But we have worse cases than the occasional destructiveness of
acute mania to deal with. In some forms of general paralysis there
is great and persistent destructiveness, with extravagant delusions,
unwillingness to wear any sort of clothing, or to he under any sort
of covering. The expiring energies of life seem to be concentrated
upon ripping and tearing everything that comes within reach. Some
subjects of this sad disease will at certain times manage to destroy
padded rooms, and it is then very diflBcult to know how to dispose
of them. Medical treatment — digitalis, opium, the wet sheet — will
not touch their malady. The hyperaesthesia and preternatural heat
of skin are indications as plain as indications can be that the soft

1867^1 ii/ Dr. Edgar Sueppard. 78

and unirritating wrappings of the atmosphere are the most soothing
and adaptive clothing ; and the very destructiveness of the patient
is confirmatory of this view. He is in the condition of one who
enters the hot chamber of a Turkish bath, minus the relief aflForded
by perspiration, and, like him, is intolerant of clothing. There is
another typical member of a great race of the human family to whom
likewise he might be compared — ''the naked negro panting at the
line.^^ To him also would clothing be insupportable misery. And
surely if the processes of disease are such as to acutely heighten
sensibility and temperature, and develop a condition analogous to
that of one at the equator, or in a chamber heated artificially to
130° or 140°, it is obvious that these three states should be met by
arrangements in some sense similar, and in every sense comforting.
Can the existence of insanity aflFect the principle which equally
underlies the three states alluded to ?

In some cases of general paralysis this dermal hyperesthesia and
elevation of temperature are not continuous, but liable to fluctuation ;
the destructive mania then commonly fluctuates with it. This is
very remarkable and confirmatory of the views advanced. The
destructiveness is often commensurate with the need of nakedness.
It is known also that in other cases sensibiUty is deadened, and the
temperature of the skin is rather depressed than elevated: here
warm shirts fastening behind are indicated, to protect the patient, as
for as may be possible, from undue exposure. But it seems to me
that where this destructive propensity reaches such a pitch as to
render it foolish to put a man in a padded room, or to give him
any covering, there is only one course open to us which can be called
humane, because it is not connected with restraint. A few single
dormitories, ranged side by side, and lined with kamptulicon,
linoleum, india-rubber, or some other durable yet yielding sub-
stance, would constitute soft and pleasant surroundings for a naked
patient. These chambers might be heated, when necessary, by a
common apparatus, to a temperature varying with the season of the
ear and the individual requirements of the patients as indicated
y the thermometer applied to the skin. Such rooms, well venti-
lated, and of ample cubic space, would be admirably adapted to
dirty and destructive general paralytics, never, in certain stages and
types of the disease, in one position, never sleeping, standing up
more than ten hours out of twelve. They would be at once the
greatest security and the greatest comfort to the patient.

It is not pretended (to recur to the cases which have elicited these
remarks) that I had such chambers as these for the patients Hobbs
and Harrison. Unfortunately, I had not. And so, under the
pressure of short supplies, caused by the coincidence in point of
time of much destructiveness on the part of other patients, they-
were placed in rooms which had no hning to the walls and flooring.-

74 On the Treatment of Destructive Patients; [April,

With this only I reproach myself. Not that I believe one moment'^
suffering was caused to any one by it. I know, indeed, that the
happiness of both patients was of the most assured though extrava^
gant kind, and that on no morning after a night of exposure to
the atmosphere was there any diminution in the temperature of
their skins.

But what I did has given rise to comments which for obvious
reasons I regret. It has created an unnecessary panic ; it has given
a handle to reckless scribblers of which they have made the most*
It has given pain also to all who are interested in the position of
this asylum, and specially to the visiting committee, who have through*
out this unfortunate business completely exonerated me from the
charge of cruelty, and treated me with a kindness and sympathy of
which I can never be unmindful.

And yet why do I say " unfortunate" ? It will be otherwise, in my
judgment, if this clamour should initiate in any asylums such a pro-
vision as that which I have above expounded. If the truth be
aoken, there are, I suppose, in every county asylum patients of the
iss we are discussing. I have at this moment^ in different stages
of their fatal malady, nearly one hundred cases of general paralysis.
Besides these there are a number of chronic maniacs, of destructive
habits. So that at times the supplies will hardly keep pace with
the exigencies of disease, as commonly viewed and regarded.

I repeat, however, that to me these exigencies are not of that
material character known as strong rugs and ticken dresses. I have
a preference for something which is more humane because unirri-
tating ; more congenial to the feeUngs of the patients because it never
can involve restraint. The most fitting dress is a warm or tempe-
rate atmosphere, unseen but yet appreciated, yielding, but ever in
closest contact, which winds itself about the surfaces with a soothing
tenderness, and permeates every pore with its gentle influences. It
is easy to shut up a destructive lunatic at night, and satisfy the
requirements of the public by giving him ordinary bedding and
clothing. But what advantageth it him if he is left unnoticed till
the morning, when he destroyed everything in the first hour of the
night ? Or how much the better is he if visited and resupplied
merely for the same process to be renewed ? What purpose is served
by such a course ? What can justify such unmeaning extravagance ?
Might not the money so squandered be applied to the provision of a
suitable atmospheric clothing which will not tear, and of soft sur-
roundings which cannot be destroyed ?

This is what I desire to bring under the notice of my fellow-
labourers, the medical superintendents of other asylums. The Com-
missioners in Lunacy, asted by me in full conclave to give some
suggestions as to their views of treatment under these perplexing
difficulties, advise me to consult my professional brethren, and are

1867.] Seviewi. 75

content to put upon leoord their disapproval of my views. In this,
the literary organ of our Association, therefore, I invite the dis-
passionate consideration of a subject about which I have been candid
and outspoken, and of a treatment which recommends itself to me
as above all tlungs humane.

It may be sad, indeed (and the reflection must occur to every
mind), to see tliose who are stamped with the Divine image, and are
supposed to be destined for something higher and better in the un-
tried future, reduced so low in the animal scale as to be insensible
to all that men commonly regard as decent and proper. But we
mast be careful that we do not on that account let our sympathy
blind us to their actual requirements. The standard of our healthy
vants and wishes is not the standard of desires which are irreparably
morbid, and of appetites which are hopelessly depraved.

There is a prevalent opinion that the administrative anxieties and
responsibilities of medical superintendents of asylums render them
specially obnoxious to general paralysis. By a righteous Nemesis
(the generous journalists who decry us will say) we are ourselves
visited by the very malady which sinks humanity lower than any
other, and the worst stages of which we have failed to make less
cruel and ungentle to the sufferer. Be it so. We must take our
chance both for the disease itself which is to end our mortality, and
for the hands which are to conduct us to the confines of the ever-
lasting shore.

PART ll.-REVIEWS.

Professor Griesin^er^s Treatise on Mental Tathohgy and Thera^
peutics.

Die Pathologie und Therapie der Psychischen KranTceiten fur Aerzte
wild Studirende von Dr. W. Griesinger, Professor der Medicin
und Director der medidnischen Klinil an der Universitdt ZilricAj
Zweite, nmgearieitete und sehr vermehrte Aujlage. Stuttgart,
I86I, pp. 538.

In our last number (January, 1867) we published an admirable
translation of Professor Griesinger's latest contribution* to the

* "An Introdnctory Lecture read at the OpeniDg of the Clinique for Nervous
tod Mental Diseases in the Royal Charity in Berlin, Ist May, 1866/' by Professor
W. Orieainger, M.D. Translated by John Sibbald, M.D. Edin., Medical Superin-
tendent of the Argyll Dbtriot Asylnm. ' Journal of Mental Science,' January,
1807.

76 ReviewH, E April,

studj of psychological medicine in the introductory lecture to his
clinical course read at Berlin, on the 1st May, 1866.

In this lecture Professor Qriesinger enforces strongly the leading
idea of his teaching, viz. that Diseases of the NervotLS System form
one inseparable whole, of which Mental Diseases are hut one variety or
species,* This position is by no means one which has been accepted
as a matter of course. It is a scientific acquisition (he writes) only
of the present day, the recognition of which will cause great changes,
remove many errors, and must open up new developments in all
directions;

The publication in English of Professor Griesinger's systematic
treatise raises interesting comparisons between the English and
German schools of psychological medicine. Practically, we are,
at least, fifty years ahead of the German school in our management
of the insane, and have much to teach and little to learn from
Germany in this regard. The lunatic wards in the Charite at Berlin
are wretched to a degree. Even the newest asylums in the capitals
of Germany, such as that at Vienna or at Munich, present scenes of
violence and noise (the fruits of the restraint system) such as would
overwhelm in merited disgrace the superintendent of any public
asylum in England. Viewed in its practical results, the teaching of
the English school — ^thanks to the labours of John Conolly — ^has
long passed the limits of comparison with that of France or Germany.
The public asylums of England — the fruit of Gonolly's work, and the
undying memorials of his fame — may be objects of imitation to those
of France or Germany ; they do not admit of comparison. It is
difficult fully to portray the broad line of demarcation which lies
between the non-restraint and the restraint systems in their results
on the treatment of the insane.

* " A comparatively small proportion of neryous diseases are foand in asylums;
and they are placed there only from outward considerations of treatment and pro-
tectiout such as the necessity for separation from the ordinary conditions of life,
isolation, occupation, &c. &c. The phase of our specialism in which these alone
were recognised as coming within its province has now been passed through, and
I believe that the time wUl soon arrive when only those will be true specialists in
psychiatry who survey the whole domain of nervous disease, and cultivate it as
widely as possible.

"It has been supposed up to the present time that the study of mental disease
was distinguished by some difficulty sui generis, and that the study of ordinary
medicine had no direct bearing upon it — that the only entrance to psychiatry lay
through the dark portals of metaphysics. And yet the other cerebral and nervous
diseases which, with the so-called mental diseases, form an inseparable whole, have
not, so fkr as I am aware, been hitherto much elucidated by metaphysics ; and in
Germany the time has quite passed away when psychiatry could be developed
from a specially philosophico-psychological point of view. Etiology, diagnosis,
prognosis, and therapeutics, are the departments in which we must seek both our
work and, that being succsssfrilly accomplished, also our fame. Therapeutics
^speciaUy derive the greatest advantage from such undivided study of aU nervous
diseases. Every acquisition in one branch of the subject exerts a beneficial in*
fluence upon the whole." — Lecture, 1866.

1867.] Jteviews. 77

As regards the theory of insanity there may, on the other hand,
be two opinions; In our English manual (Bucknill and Tuke) we
find very little said as to the seat of mental diseases, and few theo-
retical discussions on the elementary disorders of insanity or its cause
and mode of origin — subjects which occupy nearly half of Professor
Griesinger's treatise. Of course, any attempt to connect the physi-
ology of thought with its morbid manifestations must be of interest
to the student of psychology. Hitherto such efforts have generally
repuked English readers through their vague obscurity and want of
practical results.

Professor Griesinger's efforts in this direction are original con-
tributions to mental pathology, and their publication in English will
lead, as it has already done in Germany, to a more scientific and
extended study of the nature and theory of insanity.

We shall endeavour, in the following pages, to present a brief
analysis of Professor Griesinger's systematic treatise.

The first edition of this work was published at Stuttgart in
1845, when its author taught at Tubingen. The second edition
appeared in 1861, during his official connection with the University
of Zurich and previous to his recent removal to Berlin. The Frencn
translation by M. le Dr. Doumic was published in Paris towards the
end of 1865. The work is now being translated in Bussia, and the
English edition to be published for the New Sydenham Society*
will be ready for distribution early in May.

The work abounds in references to German and French publi-
cations on insanity and to papers buried in the different journals.
The extent of Professor Griesinger's reading on the subject is very
remarkable. In comparing, however, the first edition with this
second, one observes that his accurate reading and references have
hardly been so well kept up from 1845 to 1865 as during the pre-
paration of the first edition. His knowledge of English psychological
literature is unfortunately limited. He has, we have reason to
know, a third edition in preparation in which we shall hope to see
this shortcoming remedied.

The work is divided into the following five parts :

Book I. — General and Introductory to the Study of Insanity,

Book II. — The Cause and Mode of Origin of Mental Disease.

Book III. — The Forms of Mental Disease.

Book TV. — The Pathology of Mental Disease.

Book V. — The Prognosis and Treatment of Mental Disease.

• The New Sydenham Society. Series for 1867. 1. Griesinger on Mental
Diseases.— 2. Biennial Retrospect of Medicine and Surgery.— 3. Fasciculus of
Atias of Portraits of Skin Diseases. — 4. Hebra on Diseases of the Skin. Vol. IL.

78 Reviews. [April,

Book I. — The first book consists of five chapters :

Chaftbr I. — On the Seat of Mental Diseases and the Method of their

Study.
Chapter II. — ^Preliminary Anatomical Observations.
Chaptrb III. — Preliminary Physio-pathological Observations on Mental

Phenomena.
Chaptkr IV. — The Elementary Disorders in Mental Disease.
Chapter V. — On Insanity in General.

Commencing his treatise with the inquiry as to the Seat of Mental
Diseases — the first step towards a knowledge of the symptoms being
their locality — Professor Griesinger definitely takes the position
that the seat of Lisanity is in the Brain, and that in every case of
mental disease we recognise a morbid action of that organ.

The theories of Pfliiger and Schiflf, which would refer certain
phases of mental activity to other parts of the nervous system than
the brain, sprang from the sufficiently refuted assumption of the
isolated character of the mental faculties.

Professor Griesinger thus clearly states his views of the brain
being the seat of insanity :

•* Pathology proves as clearly as physiology, that the brain alone can be
the seat of normal and abnormal mental action ; that the normal state of
the mental process depends upon the integrity of this organ ; and that both
together are influenced by the state of the other organs in disease. The
invariable and essential symptoms of cerebral diseases may arise from in-
ternal causes or external lesions ; may proceed from anomalies of sensation
and movement, and, in serious diseases, even from mental disturbance
(exaltation or depression of the ideality, loss of self-consciousness, delirium
&c.). Cases of less frequent occurrence, where, with serious disorganisation
of the brain and loss of brain-substance, no disturbance of the mind is
apparent, do not invalidate the results of our everyday experience.*

* Collections of such cases are to be found, as in Longet (' Anat. et PhysioL
d. Syst. Nerv.,* Paris, 1842, i, p. 670). With reference to most of these and other
nmilar cases with which we are acquainted, different opinions may be held. In
almost all, intelligence, in the narrow sense of the word, is alone considered ; the
circumstances of disposition and win are entirely overlooked ; and even to the
intelligence but slight tests are applied to prove its integrity, such as the answering
of simple medical questions. In none of these observations has the inteUigence
been tested in its full extent, and in many, particularly in aU hospital cases^ a
comparison of the mental condition after the disease or loss of substance witlf the
earlier state was absolutely impossible. All nicer distinctions, therefor*; cannot
be considered. Notwithstanding; it must be admitted that there UMif be disease
and loss of brain, and yet no appreciable disturbance of the mental life. Very
much depends upon the seat of the disease ; aU parts of the brain do not stand in
the same close relation to the mental functions ; some stand much more in relation
to muscular movement (Pons, Thalami, Ac.). Further, with the brain, as with aU
other bilateral organs, it is highly probable that a compensation is made by the
remuning healthy half (see § 15). Lastly, we frequently find limited anatomical
lesions in other important organs without any striking functional derangement
(chronic gastric ulcer, pleuritic adhenons, tubercle, &c.) ; and loss of substance
(through gangrene) has likewise been observed, as in the lung^ or in the bowels.

1867.] Reviem. 79

If, then, insanity be only a complication of symptoms of various
morbid states of the brain, the question might be asked, whether its
special study apart from that of the other diseases of the brain can
be justified, or whether mental pathology should not rather always
accompany cerebral pathology ?

To this question Professor Griesinger gives the following reply :

" Although at some more distant period this may perhaps be looked for,
any attempt at such a combination would at present be premature and quite
impracticable. If the intimate fundamental union which exists between
insanity and the other cerebral diseases be only constantly kept in view, — if
in the one, as in the other group, the same exact anatomical physiological
method be as far as possible pursued, — cerebral patholosy will not be
retarded, but rather advanced, by the formal specialising and monographical
elaboration of these diseases classified according to their symptoms. As
psychiatrie must assert the position so lately obtained for it — as a part of
cerebri pathology, and as several of its practical phases, asylum economy,
its medico-legal bearings, &c., invest it witn an extent and character peculiar
to itself, which under all circumstances, even when viewed as a part of
cerebral pathology, keep it distinct, any attempt to obliterate that distinction
would at present be still less justifiable.

Thns the study of mental disease must be a study of physical
phenomena, and although we are quite unable to connect the mental
symptoms with direct charges of cerebral structure, we have learnt
enough to know that in that path alone can we hope to attain defi-
nite progress.

The second and third chapters are occupied with a consideration
of the anatomy and physiology of the nervous system. They are
the hardest chapters in the book, and mark a definite advance in
the study of mental physiology.

In the fourth chapter Professor Griesinger passes to the general
consideration of the elementary disorders in mental disease. These
he divides into

I. Elementary Intellectual Disorders.

1. Anomalies of sentiment (emotional disorders).

2. Anomahes of thought (intellectual disorders).

a. Formal deviations (confusion of ideas ; loss of memory, &c.).

b. Perversions of thought (false ideas, delusions, &c.).

3. Anomalies of the will (absence of volition, morbid im-

pulses, &c.).

II. Elementary Disorders of Sensation,

1. Anomalies of sensibility, ansesthesias, Src.

2. Hallucinations and illusions of sight, hearing, &c.
in. Elementary Disorders of Movement.

The cataleptic, epileptic, and paralytic states.

where, after recovery, the process of respiration or of digestion proceeded without
apparent intermption. Such ikcts, however, woald not readily be admitted in
oppofiition to the tenet, that the lungs are the organs of respiration, and that
digestion takes place in the bowels.

80 Reviews, [Aprils

I. Elementary Intellectual Biaorders, — a. Anomalies of senti-
ment,— Dr. Bucknill, many years ago, in the 'British and Foreign
Medico- Chirurgical Eeview/ pointed out the emotional origin of
insanity. Professor Griesinger teaches a similar doctrine. The
following paragraph is a fair sample of his method of argument :

^* ObservatioQ shows that the great majority of mental diseases are first
manifested, not by senseless discourse or extreme acts, but by morbid
changes of disposition, anomalies of the self-sensation and the sentiments^
and consequent emotional states. And, indeed, the earliest stages of in-
sanity generally consist in an aimless feeling of ill-humour, discomfort,
oppression, and anxiety, owing to the fact that the new groups of ideas and
instincts resulting from the cerebral affection are usually at first exceedingly
obscure. On this account the disturbance of the normal process of thought
and will, and the new mental states obtruding on the ego, are first felt simply
as vague modifications of the sentiment and disposition. The diminished
power and energy of the ego, the contraction of its sphere of ideas, produces
an indefinite 8tat« of mental pain, and, from its vagueness, great irritation of
the feelings. The new morbid perceptions and instincts produce divisions
of the mind, a feeling of division of the personality, and of imminent anni-
hilation of the ego. The mental pain discovers itself in some of the familiar
forms of agitation, anxiety, sadness, and entails all the forementioned con-
sequences of a radically changed reaction towards the external world, and of
a disturbance in the motory function of the mind. Perversions of the
natural feelings, aversion and hate towards those formerly ioved, outward
insensibility, or a morbid fondness clinging to a single object, but without
the depth and tenderness of the normal sensation, and subject to rapid and
capricious changes, are here ordinary appearances. The increased sensi-
bility involves everything, because, indeed, it is painfully affected by every-
thing, and, from the mournful complexion that pervades all his views and
opinions, the individual puts an evil interpretation upon everything present,
and discovers in the future nothing but evil. Distrust and suspicion are
engendered by the feeling of diminished power of resistance, and are con-
stantly excited by bodily feelings of anxiety. Everything appears strange
to him, because he acts strangely towards every mental impression, because
he himself feels altered, and he feels a strong inclination to ascribe his con*
dition sometimes to the direct influence of the outer world — to believe that
he is pursued, influenced, charmed, governed by secret influences— and at
others to refer to his former life for the causes, and to accuse himself of a
variety of serious crimes, depravities, and misdeeds, of which his present
position is the necessary consequence.

h. Anomalies of thought, — These are divided into (1), formal de-
viations ; (2), perversions of thought. Formal deviations of thought
are evidenced either by general loss of coherence or more or less
deficiency of certain elements^ as memory. The former exists in
chronic mania, the latter in dementia.

Perversions of thought. All mental disease tends to intellectual
disorder or perversions of thought, whether in its earlier stage it be
characterised by emotional disorder, or mental weakness, or loss of
certain intellectual powers. Professor Griesinger is happy in his
explanations of the mode in which intellectual disorder (perversions
of thought) arise in the insane.

1867.] Reviews. 81

** The false ideas (he says) and conclusions, which are attempts at expla-
nation and vindications of the actual disposition in its effects, are sponta-
neouslj developed in the diseased mind according to the law of causality ;
on the part of the individual the explanations do not imply reflection, still
less are such conclusions formed by the tedious form of syllogism. At first
the delirious conceptions are fleeting ; the / perceives them, it may be terri-
fied by them, acknowledge their absurdity, and yet feel quite unable to rid
itself of them, and sirug^es with them ; gradually, by continued repetition,
they gain more body and form, repel opposing ideas and form connections
with similar masses of perceptions of the // then they become constituent
parts of it, and the patient cannot divest himself of them, or only in some
degree by exchange with similar false perceptions. The excited, lively, and
happy insane ideas are naturally received by the 1 much more easily and
completely ; it yields to them after a short resistance, and then it occasion-
ally gives itself over to the insane perceptions, half-conscious imagination in
a world of happy dreams arises.

" All false ideas, however, are not to be considered as thus explicable ;
many originate witii the fortuitous abruptness of hallucinations, or of those
peculiar quaint thoughts which often spontaneously intrude on the healthy
mind during its most earnest employment. They often originate simply
from phantasms of sense, dreams, owing to external circumstances ; their
persistence depends on the present disposition of the patient, and whether
m the present perceptions any material for connection is found. We will
find, on carefiil attention, that many such ideas in the insane are related to
hallucinations, which, however, do not clearly show themselves.**

c. Anomalies of the will. — ^Volitional disturbance is a marked
element of intellectual disorder, and we observe at one time entire
suspension of the will; at another, its uncontrolled exercise with
increased energy. The power of the insane to control volition is a
question often debated.

The following is Professor Griesinger's judgment on this point :

" Whether, and to what extent, certain directions of the will and impulses
in the insane, particularly such as lead to criminal acts, are irresistible, is a
question which can scarcely ever be answered with certainty. Few of the
acts of the insane have the character of forced, purely automatic movements ;
in mania also, according to the testimony of individuals who have recovered,
many of the wild desires could often be restrained ; the criminal deeds of
the insane are not generally instinctive. The loss of free will (or, if we
choose, irresponsibility), therefore, seldom depends on the fact of inability to
have abstained from the act committed, or that the normal conditions of
volition have been completely suspended. The causes of this loss of free
will chiefly depend on quite a different cause, they depend on violent excita-
tion of the emotions, or on incoherence, on false reasoning proceeding from
ddirious conceptions, hallucinations, &c.

H. Elementary disorders of sensation, — ^These consist in anoma-
Ues of sensibiUty (anaesthesias, &c.), and of hallucinations and
illusions. The latter are by far the most important. By hallucina-
tions, according to Professor Grjesinger, we understand subjective
sensorial images, which, however, are projected outwards, and

VOL. XIII. ^

82 Reviews. [April,

thereby become, apparently, objects and realities. By an illusion is
meant the false interpretation of an external object. It is an hallu-
cination when I see human forms while in reality no man is near, or
hear a voice which has not spoken ; it is an illusion when I take a
bright cloud in the heavens for a fiery chariot, or when I believe
that I see an old friend when a stranger walks into the room. In
hallucination there is no external objects, it is a false sensation ; an
illusion is a false construction, a transformation of a peripheral
sensation.

Hallucinations may occur in all the senses, in the senses of sight,
hearing, smell, taste, and cutaneous sensibility. Professor Gries-
inger states the following to be the causes of their origin : —

" (1) Local disease of an organ of sense may become the source of senso-
rial delirium; therefore it is always necessary minutely to examine the
patient in this respect.

** (2) All states of deep exhaustion, whether of mind or of body, appear
to favour the development of hallucinations. As, in former times, the strong
asceticism from religious motives was a cause of numerous hallucinations, so
at the present time we very frequently see the sensorial delirium coming on
after inanition, prolonged fasting, or other exhausting cause, great mental
fatigue, &c. This is particularly favoured by one-sided mental concentration,
by superstitious ideas when fervently maintained (Benvenuto Cellini, many
devils and religious visions).

'* (3) The morbid emotional states from which insanity so frequently origi-
nates evoke hallucinations and illusions in the same manner as the analogous
states in health, fear, fright, &c., obscure the sensorial perception and awaken
new and false sensorial images.

*' (4) Outward calm and stillness favour hallucinations, and the production
of hallucinations between sleeping and waking is a circumstance of special
importance.

" (5) Certain poisons and substances used in medicine can very efiectually
call forth hallucinations, especially the preparations of hemp, belladonna,
stramonium, &c.'*

III. Elementary disorders of movement. — Under this third head
Professor Griesinger includes the remaining forms of so-called in-
sanity— the cataleptic, epileptic, and paralytic states.

The last chapter of Book I treats of Insanity in general; of —

a. The analogies of insanity^

b. The general diagnosis of mental disease.

The analogy of insanity to dreams and to the dehrium of fever is
more pressed by Professor Griesinger than we are disposed to admit.
We rather concur with Georget in regarding the delirium of fever
and mental disease as specifically different.

As regards the diagnosis of insanity Professor Griesinger gives
six criteria from which an individ^ial may be pronounced insane.

(1) . The chief point is invariably this — that, in the great majority

1867.] Reviews. 83

of cases^ there appears with the mental disease a change in the
mental disposition of the patient in his sentiments, desires, habits,
conduct, and opinions. He is no more the same; his tormi^x ego
becomes changed ; he becomes estranged ifrom himself.

(2). Should the consequent change in the habits of the patient or
the suspected exaggeration of certain phases of his individuality
have occurred under circumstances which, according to expe-
rience, may be viewed as causes of insanity, or if the individual has
been so situated as to be exposed to important exciting causes, we
can, with still greater confidence, pronounce his state to be one of
mental disease. Hereditary predisposition, nervous constitution,
injuries to the head, dissipation, hysteria, epilepsy, may be mentioned
as examples of the most important predisposing causes ; while dis-
appointment, fright, acute disease, the puerperal state, are amongst
the most frequent exciting causes.

(3). The symptoms of mental diseases consist only to a small
extent of definite,' isolated, and unmistakeable morbid appearances,
and never in any case of directly palpable and physical signs. They
depend essentially on the interpretation of the mental acts by an
observer acquainted with disorders of the mental functions and
their modes of expression. Two individuals may say and do the
same thing ; for example, they may express their beUef in witch-
craft, or. the fear of being eternally lost; the intelligent observer
would declare the one to be healthy and the other to be insane.
This judgment is come to by a consideration of all the accompanying
circumstances, and from a knowledge gained by experience of the
various forms of insanity and their accompanying phenomena.

(4) . Symptoms of bodily disease ascertained by the state of the
pulse, the digestion, the secretions, &c., cannot naturally, in any
case, be taken as proofs of mental disease ; the diagnosis depends
essentially and exclusively on the mental symptoms. Nevertheless,
those symptoms of diseases in other parts may be of great value.

(5). From the physiognomy, gestures, words, and actions of an
individual, we learn the essential symptoms, those of the mental
state. But there are cases where the external signs mislead, as the
insanity is sometimes simulated, or — ^but not so frequently — ^feigned.
When dissimulation is suspected, the following circumstances should
especially be considered. The simulator, if he does not possess
special psychiatrical knowledge, very seldom succeeds in correctly
feigning tiie symptoms of any one form of mental disease. He
generally mixes the appearances of several forms with each other, so
that an unnatural representation of disease is offered. Moreover,
he usually overdoes the phenomena of mental disturbance. He be-
Heves that all must be reversed ; instead of giving expression to
delirious conceptions, he talks absurdly, and conducts himself as if,
m insanity, the greater part of the intelligence and of the memory

84 Reviews. [April,

must be disturbed ; acts as if he could no longer count, read, write,
or tell his name, &c.

(6). Simulation excluded. Professor Griesinger dwells, lastly on
the (fifficulty which remains of accurately determining whether after
all a man be sane or insane P

''The question (he says) whether mentally diseased or not? is by no
means a correct one. There are no well-marked boundaries between health
and disease in general ; there is, in mental as in other pathology, an interme-
diate territory of disorder which is not yet fully developed disease, and
where the individual still exhibits many of the characteristics of health. Is
not this the case with the simplest bodily troubles P Where is the exact
point at which we pronounce a man blind ? Only where there is absolutely
no appearance of light ? Or, who is dumb ? Who is dropsical ?' The in-
dividual who has the slightest trace of oedema ? If not, where does the
limit of dropsy commence ? When there are extremes, all are agreed.
When the degrees are slight, we may even argue whether these signs may be
taken into consideration in the case.

'*In mental medicine, however, many medico-legal cases fall within this
category; for example, of deeds done in passion by persons habitually
moody, and those of weak intellect — of habitual moderate excitement, or of
perversion with temporary distraction, of drunkenness, hysteria, &c. ; cases
of which it must ordinarily be said that the individuals are not in a healthy
mental state, but the marks of definite mental disease cannot be clearly dis-
covered ; therefore it is more probable than certain that their actions are
regulated, or at least greatly influenced, by morbid organic causes. In the
mode in which these actions are expressed there is, indeed, no marked line
of distinction between eccentricity, passion, perversity of desire, dulness of
sentiment, and mental disease ; there is no constant sign from which we can
tell whether those states result entirely from organic disease (morbid), or
only partially from such, or whether they exist without organic influence, as
original traits of character, or as the hereditary results of the psychical in-
dividuality. All existing phenomena of cerebral disorder, hallucinations,
paralysis, &c., and all physical morbid appearances, are here of special
value."

Book II. — ^The second book treats at great length of the causes
AND MODE OF ORIGIN OF MENTAL DISEASE. The causcs are divided
into general predisposing causes and special predisposing causes.
They are thus defined by Professor Griesinger :

*' Under the head of causes in mental as in general pathology are under-
stood all the diflerent classes of circumstances to which may be ascribed an
influence on -the development of the disease, although their mode of connec-
tion may be variously exhibited. The causes comprehend, on the one hand,
the external circumstances (nationality, climate, season of the year) under
the influence of which insanity is generally, with more or les^ frequency,
observed ; on the other hand, they signify certain external injuries (sun-
stroke, wounds of the head, of which insanity is frequently a consequence ;
finally, they comprehend certain internal states dependent on the organism
itself (hereditary disposition, previous disease, or other general disturbance
of the organic mechanism, such as disease of the lun^s, the senital organs,
&c.) whicn wc know by experience have an influence in the development of
insanity. In very many of these circumstances the intimate connection be-
tween them and the influences ascribed to them, the mode in which from

1867.] Reviews. 85

them the mental disease is developed, is scarcely ever or not at all evident.
The conclusion post hoc ergo propter hoc depends, therefore, on a simply em-
pirical (statistical) knowledge of the fact that these particular circumstances
(for example, hereditary disposition, very frequently coincide with, or pre-
cede, the commencement of the insanity. In other of these sa<!alled causes,
their mode of action, the manner in which, in consequence of them, the dis-
ease is established, can be comprehended. But the province of etiology in
die narrow sense is only to enumerate empirically the known circumstances
of causation ; it belongs to pathology to explain the physiological connection
between cause and effect, to show the particular mechanical act by means of
which insanity is induced through a given circumstance (for example, ex-
cessive depressing emotion, heart-disease, &c.), a task towards which we
have hitherto done little more than prepare the way."

The whole subject of the causation of mental disease is admi-
rably treated throughout this second book. Professor Griesinger
passes in review the predisposing and exciting causes illustrating each
section with a mass of observation and reading on the phenomena
of insanity, such as one would in vain look for elsewhere. This
subject occupies from p. 127 to p. 205 of the English translation
of his work. Our limits prevent our foUowmg out the detail treat-
ment of this question by Professor Griesinger. We conclude our
present observations on this work with the following extract, in which
he briefly sums up the result of his investigation into the causes of
insanity : — " From this enumeration of the causes of insanity (he
writes) the general doctrine may have been deduced that everything
which lowers the nutrition, all true states of weakness, and ftirther
that all circumstances which over-excite the nervous system, which
&vour congestion of the nervous centres — ^in short, all which have as
a result the development and fixing of the nervous constitution,
may become causes of insanity. We shall again revert to this
subject when we come to speak of the treatment of mental dis-

eases.'*

{To be continued.)

Modem Culture: its triie aims and requirements, A series of
Addresses and Arguments on the Claims of Scientific Education.
Edited by Edwaed L. Toumans, M.D. Macmillan and Co.,
. 1867.

What kind of culture the growing mind of the nation shall have
is without doubt one of the most important questions which can rise
for consideration. The neglect of science in the prevailing system
of education, and the undue time and labour bestowed orx the etudy .

86 Reviews, [A-pril,

of the dead languages, prodace evil consequences which would have
long since arrested attention, were it not that the majority of men
regard as the greatest evil any change from the accustomed routine
of thought and practice. By bringing together the opinions of
eminent scientific men, regarding education, such as Faraday, Paget,
Daubeny, TyndaD, &.c., as for the most part contained in lectures
delivered by them. Dr. Youmans has done a very useful work.
Professor Tyndall lectures on the study of physics ; Dr. Daubeny
on the study of chemistry; Professor Henfrey on the study of
botany ; Professor Huxley on the study of zoology ; Mr. Paget on
the study of physiology ; Dr. Whewell on the educational history of
science; Faraday on the education of the judgment; Dr. Hodgson
on the study of economic science. A fragment from an essay by Mr»
Herbert Spencer deals with the subject of political education ; Pro-
fessor Masson treats of college education and self-education ; while
the editor himself contributes a philosophical lecture on the scientific
study of human nature. After pointing out the emptiness of the
metaphysical method of studying of mind, he says —

** Sufficient, I trast, has now been said to show that mental operations are
so inextricably interwoven with corporeal actions, that to study them suc-
cessfully apart is altogether impossible. The mental life and the bodily life
are manifestations of the same organism, growing together, fluctuating
together, declining together. They depend upon common laws, which must
be investigated by a common method ; and science, in unravelling the mys-
teries of the body, has thrown important light upon the workings of the
mind. It only remains now to point out, that when subjected to the
Baconian test of ** fruitfulness" — of practical application to the emergenciea
of experience — the scientific method of regarding human nature, incomplete
as it may be, already stands in marked contrast to the proverbial barrenness
of the old metaphysics.

" One of the gloomiest chapters of man's social history is that which records
the treatment of the insane. Those upon whom had fallen the heaviest
calamity possible in life were looked upon with horror, as accursed of God, and
treated with a degree of cruelty which seems now incredible. Asylums were
dark and dismal jails, where their inmates were left in cold, hunger, and
filth, to be chained and lashed at the caprice of savage keepers. And this
barbarism continued in countries claimmg to be enlightened, down to the
middle of the present century. Let me mention a solitary instance, of
which the literature of the subject is full.

**Said Dr. ConoUy, in a lecture in 1847 — *It wfes in the female infirmary
at Hanwell, exactly seven years ago, that I found, among other examples of
forgetfulness of what was due either to the sick or insane, a young woman
l^ing in a crib, bound to the middle of it by a strap around the waist, to the
sides of it by the hands, to the foot of it by the ankles, and to the head of it
by the neck ; she also had her hands in the hard leathern terminations of
canvas sleeves. She could not turn, nor lie on her side, nor lift her hand
to her face, and her appearance was miserable beyond the power of words to
describe. That she was almost always wet and dirty it is scarcely necessary
to say. But the principal point I wish to illustrate by mentioning this case
is, that it was a feeble and sick woman who was thus treated. At that very
time her whole skin was covered with neglected scabies, and she was suf-
fering all the tortures of a large and deep-seated abscess of the breast/

1867.] Reviews, 87

** ' A^in/ he remarks, * old and young men and women, the frantic and
ihe melancholy, were treated worse, and more neglected than the beasts of
the field. The cells of an asylum resembled the dens of a squalid menagerie ;
the straw was raked out, and the food was thrown in through the bars, and
exhibitions of madness were witnessed which are no longer to be found,
because they were not the simple product of malady, but of malady aggra-
vated by mismanagement.'

" Now these statements represent a condition of things as old as history,
and we are called upon to account for it. Granting that the insane were
dangerous, and required restraint, and granting all jthat may be urged con-
cerning the barbarity of the times, we have yet to find the cause of the
apparently gratuitous ferocity of which they were the victims ; and this we
do find in the legitimate consequences of the prevailing theory of human
nature. The ancient philosophy taught that the body is to be despised,
degraded, renounced. This view was adopted by theology, and thrown into
a concrete and dramatic shape, which made it more capable of vivid realisa-
tion by the multitude. It pronounced the body to be ' a sink of iniquity,*
*the intrenchment of Satan,' a fit residence for demons. The lunatic was
one who had incurred Divine displeasure, and was given over to the powers
of darkness, by whom he was ' possessed.' This doctrine, of which witch-
craft was one of the developmetits, abundantly explains the attitude of
society towards the victims of mental disorder. What more suitable than
dungeons, scourgings, and tortures for the detested wretch, who was thus
manifestly forsaken of God, and delivered over to the Devil ? The merciless
brute who inflicted untold sufferings upon these unhappy beings deemed
himself, like the inquisitor, but an instrument for executing the will of Heaven.

" It availed nothing that, for thousands of years, there had been a broad
current of intense and powerful thought in the channels of poetry, polemics,
oratory, philosophy, politics, theology, and devotion. AH this multifarious
culture was powerless to arrest the evil consequences of a radically erro-
neous yiew of human nature, for the simple reason that the discovery of
truth was not amon^ its objects. It was only when a class of men, partici-
pating in the new spirit of modern times, and drawn to the investigation by
the necessities of their profession, entered earnestly upon the study of the
body, that views were reached which have revolutionised and humanised the
treatment of the insane. Discovering that the mind is dependent upon the
organism, and that its disordered manifestations are the results of organic
derangement, they found that insanity is not a devil to be exorcised, but a
disease to be cured. After a sharp struggle with popular ignorance and tra-
ditional prejudice, the better views have triumphed, and society is beginning
to reap the beneficent consequences of their labours ; the stern and violent
measures, that served but to aggravate the malady, have given place to
gentle and kindly treatment, which is found to be of itself a most potent
means of restoration,

*' The management of the idiotic, or feeble-minded, equally illustrates the
argument. Throughout the past no movement was made for the relief of
this wretched class, and no one dreamed that anything could be done for
them ; but the progress of physiology has made a new revelation in this
field also. Dr. Edward Seguin, in his remarkable work upon ' The Treat-
ment of Idiocy by the Physiological Method,' observes : ** Idiots could not
be educated by the methods, nor cured b^ the treatment, practised prior to
1837; but most idiots, and children proximate to them, may be relieved, in
a more or less complete measure, of their disabilities by the physiological
mode of education.
** These facts have a profound significance. They not only show that to

be fraeiieable which the world had never suspected to be possible, and that

88 Report on the Progress [A.pril,

science is true to her beneficent mission in the higher sphere as well as in
the lower ; they not only show that a change of method in the study of
human nature ended some of the grossest barbarisms of the past^ but they
involve this deeper result — ^that by reaching a knowledge of the true causes
of insanity and imbecility, we gain command of the means of their prevention,
and arrive at the principles of mental hygiene/'

PART III.-QUARTERLY REPORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.

I. — German Psychological Literature.

By John Sibbald, M.D. Edin., Medical Superintendent
of the District Asylum for Argyllshire,

Zdtschrift fur Psychiatrie, vols, xxi, xxii. — " On the Influence
of Intermittent Fever on Insanity/^ Dr. W. Nasse ; ^' On the fieten-
tention of Memory in Insanity/' Dr. C. Pelman; " On the Results
of Treatment at Gheel,'' Dr. F. Wiedemeister ; " Contribution to
the Knowledge of doubtful Morbid Conditions of the Mind/' Dr.
Wille; ''Cold Bathing in Cases of Insanity/' Professor Albers,
Dr. Pinkelnburg ; '' Insanity resulting from the presence of Echino-
cocci in the Brain/' Dr. Knoch ; '' Tabes Dorsalis and Paralysis
universaUs progressiva/' Dr. Westphal : " the Treatment of MeLan-
choUa with Opium/' Dr. Tigges ; " A Simple Instrument for deter-
mining differences in the Size of the Pupil/' Dr. P. Obernier ; " the
Development of Grey Cerebral Substance in the Walls of the Lateral
Ventricles/' Dr. Meschede ; " Hereditary Tendency in Insanity/'
Dr. Jung ; " Typhus in the Insane/' Dr. Wille ; " A New System
of Measurement of the Head/' Dr. F. Obernier ; ^^ A Contribution
to the Subject of Diminished Responsibility/' Dr. Flemming ; ^' In-
sanity connected with Hydrocephalus/' Prof. Albers ; " Cretaceous
Tumours in the Insane/' L. H. Eipping ; " Statistics of the Asylum
for Curables and Incurables at HaUe/' Dr. Damerow.

On the Influence of Intermittent Fever on Insanity. — ^Dr. Nasse,
of Siegburg, discusses the supposed favorable influence of inter-
mittent fever on the progress of insanity, which has especially been
maintained by Koster. He details seventy-six cases of this disease
occurring in connection with insanity, which he had observed during

1867.] of Psychological Medicine. 89

nine years and a half which he spent at the Sachsenberg Asylum. In
eight of these, cases recovery had already taken place before the
fever occurred, and no recurrence of the mental symptoms took
place. In two cases recovery began immediately after the attack
of intermittent fever, and rapidly became complete; in 3 this
fever was followed by lasting improvement ; in 14 there was an
improvement which, though not altogether permanent, continued
for a considerable time after the fever had subsided, and in 7 there
was an improvement which only lasted during the entire course of
the fever ; so that, in all, there were 26 cases in which a favorable
change accompanied the attack. In 39 cases, however, no result
appeared to be produced, and in 3 the febrile condition was followed
by unfavorable mental symptoms. These statistics fall far behind
those of Koster in testifying to the supposed curative influence.
In his statement he gives, out of 24 cases, 7 as recovered, 7 as
improved, and only 10 as having received no benefit. But it must
be observed that a detailed comparison of the two lists shows this
important peculiarity in Roster's cases, that the great majority
belong to the primary forms of mental derangement — melancholia,
mania, and moria. Besides 10 purely primary cases, 8 are cases of
melancholia or mania, with weakening of intellect (Schwachsinn) or
hallucinations, so that only a few cases of secondary forms of in-
sanity remain. On the other hand, only 8 oT Nassers cases were
labouring under melancholia or mania, and the remainder were, for
the most part, in advanced stages of secondary insanity. Eecovery
or decided improvement occurred specially in the melanchoha and
maniacal forms ; in 2 cases of acute mania, 2 of melancholia, and 1
of delusional insanity with hallucinations. That there is no in-
superable obstacle in the nature of the last-mentioned to the recep-
tion of favorable influence from the fever is shown by several obser-
vations both of Koster and Nasse. The total number of cases in
which the latter observed a favorable effect of the fever were in

3 out of 4 cases of melancholia.

» 4

mania.

„ 25

delusional insanity (generaUy with haUucinations)

„ 26

chronic mania, and secondary dementia.

» 5

paralytic dementia.

—

„ 6

epileptic insanity.

It might have been assumed a priori that the previous duration
of the insanity would bear an important relation to the favorable
or unfavorable effect of the fever. Accordingly, we find that the
recoveries and decided ameliorations which Koster has reported
occurred in cases which were nearly all of less than two years^ dura-
tion; and in Nasse's similarly favorable cases, only 1 had lasted
longer than two years. In all the 26 cases in which any favorable
lesolt was observed, only 4 had been longer than five years insane;

90 Report on the Progress [April,

6 were less than two years, and the durations of the other 16 were
between two and five years. From these considerations Dr. Nasse
thinks it must be allowed that neither the form nor the duration of
the insanity affords any certain criterion by which we may judge of
the effect which will be produced by the fever ; but he believes that,
in the primary forms with short duration, a proportionally favorable
prognosis may be given in regard to the psychical results of the
supervention of the intermittent. These cases may, at least, be
considered favorable, as among 18 cases (Koster) of melancholia
and mania partly complicated with hallucinations and weakened
intellect, 14, or 78 per cent., recovered or decidedly improved;
and among 8 such cases (Nasse) 4 were very favorably influ-
enced, making 69 per cent, if we take the data of both observers
together. The conditions necessary to permit of the beneficial in«
fluence of the fever probably consist in the special physical state of
the patient. Indeed, Koster suspects that favorable results are
produced only in those cases where the cerebral affection is only
functional, and particularly in sympathetic affections depending on
lesions of the abdominal organs. Nasse, though doubting the par-
ticular conclusion as to the influence of abdominal lesions, agrees as
might be expected in the belief that functional affections are most
likely to be ameUorated. He has endeavourec^ to classify those
of liis own cases in which the distinction between functional and
organic diseases could be made, and he finds that one third were idio-
pathic affections depending on primary disease of the brain, and that
two thirds were sympathetic cerebral derangements. Of the latter, a
part were to be referred to lesions, not of the abdominal organs
strictly so called, but of the genital system and also of the thoracic
viscera. He also remarks that in one case of sympathetic derange*
ment due to an abdominal lesion no change was produced by the
fever.

A recent French writer, M. Girard, who mentions an instance of
the beneficial effect of intermittent fever, supposes that it m^ be
explained as the substitution of one neurosis for another. Nasse
contends that we must look for the explanation in the effect on the
circulation of blood in the brain. The abnormal condition of this
circulation has, especially of late years, been regarded as of great
importance in regard to mental derangement; and it is probable
that the chronic forms of depression and debiUty with which such
derangement is associated, are connected with impeded and slow
circulation in the cerebral vessels (passive hyperemia of the mem-
branes, ansemia of the brain-substance, &c.) . It is also well known
that in those forms of mental derangement which are accompanied
by apparent physical health, the action of the heart and vessels is
usually distinguished by remarkable slowness and want of power.
In intermittent fever, however^ there is a strong and sudden excite-

1867.] of Psychological Medicine. 91

ment of vascular action, and a revolution in the general circulation
which must have an influence on the circulation in the brain. The
strongly-marked symptoms of congestion of the head almost always
to be observed in those suflFering from intermittent are shared in
by the cerebral circulation, as is shown by the profuse epistaxis
which has been observed to occur during that fever. Girard and
Amelung mention the occurrence of epistaxis in both the cases in
which they saw recovery from insanity follow the attack of inter-
mittent ; and Nasse reports that heat, redness, and pain in the head
with giddiness and acute delirium were usually observed in similar
cases. It is, therefore, probable that, with the acceleration of the
general circulation, there may also be the removal of partial and old
stagnations, and a sudden addition of new blood increasing not only
the general quantity but improving its quality, and that thus the
function of the part of the brain which had been impeded by the
slowness or insufficiency of its supply of blood might jhave under-
gone a kind of revivification. Special benefit might also be expected
from the frequent recurrence of this acceleration in chronic inter-'
raptions of the circulation associated with torpidity; and as the
vessels are repeatedly gorged and emptied in the course of inter-
mittent fever, more advantage may be expected from it than from
acute inflammations. Of thirteen cases of erysipelas of the head
and face mentioned by Nasse, none showed any favorable change in
the mental condition, although three were cases of recent melan-
cholia ; nor has he observed any improvement during the course of
many cases of pneumonia occurring among the insane. The asser-
tion has been made by Berthier"^ that every fever had a remarkable
effect on insanity, and that in conditions of mental excitement an
improvement of some duration is produced ; while in melancholia
and in insanity complicated with paralysis an injurious eflfect is
produced. In Nasse's cases, however, there were several cases of
melancholia among those improved and cured, and in one paralytic
distinct improvement took place.

The Retention of Memory in different Forms of Insanity, — This
subject is considered in a long paper by Dr. C. Pelman, Assistant-
Physician to the Asylum at Gorlitz. As it consists chiefly of the
details of cases observed by himself or already published by other
writers, it is impossible to present a satisfactory abstract of its con-
tents. He classifies those cases in which loss of memory is observed
into three divisions. The first includes those conditions which are
analogous in their nature to dreams, in which the mental action does
not reach the condition of consciousness or waking life. The second
includes those cases in which the mental action is so exalted that

♦ * Annal. Medico-Psych.,' 1861, vii, 1.

92 Report on the Progress [April,

ideas follow one another in such rapid succession that they do
not exist for a sufficient length of time to permit of their being pre-
served for reproduction. Aiid the third consists of those in which
loss of memory is occasioned by physical changes in the brain, as in
cases of paralysis.

On the Results of Treatment at Gheel as regards the cure of
Patients, — In this paper Dr. F. Wiedemeister, of Hildesheira, com-
pares the statistics of recoveries and deaths in Gheel with those
obtained in the asylums of Hildesheim, Vienna, Illenau, and Sieg-
burg. As regards recoveries, he shows that the proportion of
recoveries to the admissions in these asylums is considerably greater
than appears from the statistics of Gheel; but the value of his
inferences is seriously affected by his omitting to make allowance for
the large number of incurable cases which are received at the latter
place. And he calculates the deaths in relation to the number of
admissions instead of the average number resident, which necessarily
leads him again J;o very false conclusions. In consequence of these
mistakes, the advocates of the family system need not be alarmed
at the opinion which he expresses, that ^' Gheel presents great proba-
bilities that a patient will find his grave there within two years, and
little hope that he will be cured.^^ The subject is more fully treated
in another part of the present number of this Journal.

Contribution to our knowledge of Morbid Conditions of the Mind, —
Dr. Wille, formerly of Goeppingen, relates an interesting instance
of attempted homicide by a man, the nature of whose insanity was
not ascertained with certainty for a considerable time after the com-
mission of the assaidt, ^^ On the evening of the 7th of August,
A. A — , without having exchanged words with D — , his neighbour,
or having had any quarrel with him, entered his chamber and struck
him on the head with a hatchet, and thus an injury to the head and
concussion of the brain were occasioned, which threatened to be
seriously dangerous. The perpretator fled after the commission
of the deed, but was taken by the police the same night. As
the local authorities considered that the assault was committed
during a temporary aberration of mind, on account of the general
character of the man and the circumstances of the deed, he was
subjected to medico-legal examination.^' The following was the
medico-legal opinion: — ^^A — suffers from a melancholic dis-
turbance of the mind, which is not of recent origin. This perma-
nent condition is accompanied by transitory, but frequently recurring,
more or less violent determination of blood to the head, which reveals
itself unmistakeably, and has a decided influence on the manifestations
of melancholia. In short, he is at the time not only mentally, but
also physically ill ; he iin the stage of melancholic derangement

1867.] of Psychological Medicine. 93

which is manifested not by gloomy stupor, but by alternations of
tranquil, moody derangement, with attacks of exaltation, and ap-
proaches to actual acute mania. During these attacks the power
of rational self-control is absent, and in the intervals very circum-
scribed/'

In consequence of this opinion he was placed in the district hos-
pital, where he remained ten days, after which he was removed to
the asylum. According to the more detailed information which was
then obtained, he appears to have been a quiet, industrious, working
man, of infinite good humour, with no disposition to injure any one.
He was fonder of church than of the public-house, avoided
quarrels, and occupied himself much with the Bible and religious
subjects. His house was well ordered, and he was suitably married.
At school his conduct and progress were satisfactory, and at eighteen
years of age, when he finished his apprenticeship as a carpenter, he
joined a strict religious sect. When he went from home to improve
liimself as a tradesman, he sent home his savings to his aged
parents. He continued always to be a diligent attendant at all
rehgious exercises, and conducted himself with the greatest pro-
priety. In preaching, as he occasionally did, he showed great know-
ledge of the Bible, and skill in expounding it. His grandmother, a
paternal aunt, and another relation, are said to have suffered from
insanity.

The mental derangement dated from the year 1860, although it
was never subjected to medical treatment, as his friends did not
wish it to be known. Besides his relatives, however, others testified
to his derangement, and said that he had intervals during which he
was perfectly sane. In the above-mentioned year he attempted to
cure a boy of certain attacks of chorea under which he laboured, by
means of prayer, as the attacks were ascribed to demoniacal posses-
sion. When he saw the fruitlessness of his exertions, he became
thoughtful and moody, and felt so miserable and restless that he
often broke out into moaning and weeping. From this time forward
he occupied himseK greatly with mystical and superstitious notions,
and in 1862 he is said to have preached publicly at a place in the
neighbourhood. Some time before the critical event he had to pre-
pare a wooden hut in the neighbourhood. Against the wish of his
family he walked to and from his work, a distance of seven miles,
instead of going by railway, and did a heavy day^s work besides.
This occurred at the hottest season of the year. Thus far he had
shown no other traces of mental aberration than the meanings and
internal disquietude. It was on the evening of the 7th of August,
as mention^ before, that i\vt event occurred which was so little
anticipated. The family was seated at supper when he entered the
room and attempted to strike his wife with an axe, though without
succeeding in injuring her seriously j he next ran to his neighbour's

94 Report on the Progress [April,

house and struck him on the head with the axe. He then left the
axe and made off.

His behaviour after admission to the asylum was in no way signifi-
cant of much mental aberration. He Was industrious at work,
though showing in his words and actions a certain apathy and want
of interest in what went on around. His judgment appeared to be
quite correct. He seemed to labour under no delusions or halluci-
nations, and though apparently very religious, was not extravagantly
so. He was friendly and pleasant to every one, and though fre-
quently sad he states that he is so on account of his unfortunate
condition, and especially on account of the infant who, as his wife
is pregnant, is soon to be brought into the world without a father.
When he is spoken to about the cause of his having been brought
to the asylum, he explains in the clearest manner that he knows
nothing of the circumstances. " He is said to have struck a neigh-
bour with the axe, which he knows nothing about and cannot be-
Ueve. He never had any difference with his neighbour, and never
even in word injured any one; in fact, he knows nothing but that
he was seized on the road by the poUce and taken to the office,
where he first came to himself as if waking from a dream. He never was
deranged in mind, though he had suffered frequently from headache
during harvest, in consequence of great heat. Of the events of the
day on which he was arrested he is in complete ignorance, and it seems
to him as if he had not been in the world at all then.'' Before and
after that particular period he could remember every event with thie
greatest exactitude, and as often as he spoke about the affair he
always gave the same account, which he called all the saints to
witness was the truth. He remained in this condition and pre-
served this demeanour till the middle of September, when he was
attacked by typhus fever, and he seemed more depressed during
the illness than before ; it was attributed to longing for his family.

The case had thus a very peculiar history, and could not easily
be reconciled with our ordinary experience. " We have,'' as Dr.
Wille wrote when considering the case at this stage, *^a. man now
before us who has passed on to a ' lucid interval' after a temporary,
sudden, and violent attack of insanity. The attack must have come
on suddenly, and remained a very short time, for no one who came
in contact with him, either before or after the deed, observed any
remarkable excitement about him. In like manner, the man him-
self has complete knowledge of everything which occurred previous
to the event, and also a few hours after. As regards all that lies
between, he shows no trace of knowledge. Why should he conceal
the truth ? He has already been removed from the danger of punish-
ment by having been declared insane."

About the end of September, however, he made a statement which
afforded a complete explanation of the whole affair. It was with

1867.] of Psychological Medicine. . 95

great emotional excitement, and many tears, but with evident m-
ternal relief, that he related the following details :

" He had finished his harvest on August 5th, with rejoicings over
the good crop, and afterwards, at the house of an acquaintance, he
oat of good nature undertook some carpenter work for him. While
he was at work it appeared to him as if his wife was playing false to
him with his neighbour. Quite beside himself he ran home and
found his wife in the stable, who answered him very suspiciously,
but otherwise appeared as formerly. Weeping and praying, in great
grief he laid himself on the bed and spent the night without sleep.
On the next day, as he went again to his work, he explained the
matter to an acquaintance (who had originated many of his super-
stitious practices) . This person had explained it as a presentiment
such as God often has sent. He assured him that such things fre-
quently occurred, as indeed he would find examples enough in the
Bible ; and he was to watch his wife carefully. Full of trouble he
worked away till, as on the previous day, it seemed to him that he
saw his wife with his neighbour. Again he ran home, and looked
at the bed which he found newly made and wanting a pillow, which he
found dirty and laid above the bedstead. Now it seemed to him as
if everything was clear. Again, he wept, ate nothing, and weeping
again, went to bed. On this occasion, also, he did not sleep. The
next day he tried by work to banish the trouble, but it gave him' no
rest. Anger, pride, and shame had put him quite beside himself — it
came all up into his head ; and as an axe was lying accidentally in
sight, he seized it and aimed a blow at his wife, then ran to his neigh-
bour and struck him, after which he threw away the axe and ran away.
He then came to his senses, and has since remained quiet. It is
from shame that such a thing should have occurred in his house
that he has never confessed anything about it. This state of things
is no disease,^' said the patient. The foreboding was true ; he is
still assured of the unfaithfulness of his wife, and declares that such
will never happen again.

In spite of a thorough perception of the nature of his deed, he
always, when thinking of tne matter, laid the greatest stress on the
injury done to his honour by the unfaithfulness of his wife, the im-
probability of which he could not be convinced of. The conclusion
of every conversation was that he ought to be discharged as soon
as possible, and that he would never commit such an action again,
and would forgive his wife.

In October he was carried off by the fever.

Dr. Wille discusses at some length the medico-legal bearings of
the case. He concludes with the opinion that the patient suft'ered
from periodic melancholia, and that at the time of the . deed he was
in an exalted stage of mental disturbance, suffering from a severe
attack of melancholic reaction. The principal medical questions

96 Report on the Progress [April,

raised are — (1) could he have been sent back to his family after the
return of tranquillity and reason which supervened? or, if not,
could he have been sent after passing a longer period of persistent
mental health P In such cases, we must confess that medical science
does not afford such data as would permit us to express ourselves
with certainty as to whether a relapse would take place or not, nor
whether a relapse would be of a character as dangerous as the
former attack. It is always probable, however, in iUnesses of three
years' duration, that they will return. Whether the attack will be
like the previous one is impossible to say. On the ground of
medical responsibility the detention of this patient was required for
the protection of those about him.

On Cold Bathing as a Remedy in Mental Disease, — Though there
would be no advantage to be obtained from the adoption of the
eccentricities of what is called the water cure in the treatment of
insanity, there is no doubt that the remedial efficiency of various
kinds of bathing in different forms of mental derangement has not
yet received the attention which it deserves. We believe that a
great deal of the benefit derived from residence in any asylum is
due, at present, to the regular bathing which is carried on for the
fulfilment of hygienic requirements. The function performed by
the secreting textures of the skin is one of the most important in
the preservation of health ; and the ablutions which are necessary
to permit its healthy exercise are comparatively little practised or
even known among the masses of the population. It would be
strange, then, if important good did not result from the restoration
to healthy activity of a function which has frequently been for years
in abeyance. But the ordinary bath fulfils oidy one of the objects
which may be attained by the medical applications of water and air.
It merely clears the openings of the ducts, and gently stimulates the
secretion. Prolonged bathing may not only exert a more powerful
influence of the same kind, but it may also, among other actions, be
employed for elevating or lowering the temperature of the body in a
more satisfactory manner than can be obtained by any other method.
The establishment of Turkish baths in some of our asylums will, no
doubt, be followed by satisfactorily conducted investigations into the
circumstances which indicate or contra-indicate their employment.
There is still, however, much to be done in studying the action of
the ordinary cold or hot- water bath on the different forms of disease.
Much discredit must accrue to the remedy and disadvantage to our
science if we do not seek carefully to separate those cases in which
their use is hurtful or useless from those in which good results may
be expected.

The following contribution from the pen of Professor Albers, of
Bonn, appears to be of sufficient importance to be given in full :

1 86 7 .] of PsycJwlogical Medicifie. 9 7

" A form of melancholia agitans occurs in which a considerable
distension of the veins of the lower parts of the cheeks, nose, and
coDJnnctiva makes it probable that a similar condition exists in
the brain. This again may form the stimulus which keeps up the
excitement, and, perhaps, feeds the melancholia. Considerable
emaciation frequently shows itself in this disease, associated with
considerable musculai power. There is also considerable elevation
of temperature, and cold is only slightly felt. The appetite remains
very good, and the secretions are active, but the patient suffers from
externa sleeplessness. He sleeps only for a few minutes at a time,
either by day or night, and he occupies himself with continual talk-
ing to himself, sighing, bemoaning, or leaping, and other ways of
keeping up increasing movement. In some cases this melancholia
originates in childbed. During pregnancy, an extensive dilatation
of the veins makes its appearance, which may afifect one of the lower
extremities, generally the right. The venous distension about the
face and nose is also generally present, when it exhibits a dark and
dirty-red colour. At a later stage melancholia often comes on. The
longer the illness continues, so much the more does the restless-
ness increase, and at last the patient can scarcely remain at rest,
or rather is condemned to continual wandering ; is impelled to pull
her clothes to pieces and to destroy every article of clothes which
fihe wears, or, indeed, anything which comes within her reach. She
scratches the walls, and if the motion of hands and feet is impeded,
she carries on the destruction with her teeth. I have seen some
who gnawed even the doors and lining of the door-posts. In course
of time they become very dirty. Urine and faeces are voided some-
times voluntarily, sometimes involuntarily — at any time or in any
place, and frequently in the clothes or bed. The delusions under
which these patients labour are of a powerfully depressing kind —
everlasting perdition ; despair of recovery ; belief in having fallen
into hell, or in being condemned to wander beneath the earth ; and
generally the apprehension of continually impending misfortune
about to fall on the children, relations, and all who are or have
been dependent upon them. The same delusion keeps command of
the patient with shght fluctuations in strength, which are corre-
spondingly indicated in speech and action, thus rendering this form
of melancholia agitans very troublesome, both to the friends and to
the physician. It is fortunate, however, that it only in rare instances
passes on by reaction to actual violence.

** In this disease I have succeeded in obtaining rest by gradually
diminishing the temperature, which was effected by means of water
of 54° Fahr., and in one case I succeeded in obtaining complete
lecovery.

''It is known that the rapidity of the circulation decreases,
and the sensation of nervous irritability becomes lessened if one

VOL. xin. 7

98 Report on the Progreis [April,

of the limbs or the whole body be immersed in water of the ordi-
nary temperature. Not only are the redness and pain of burns
and wounds diminished by prolonged immersion of the injured
member, but paleness and either partial or complete removal of
pain are produced in any inflamed part which is thus treated. Con-
tinued bathing in water of 55° to 65° Fahr. produces fatigue. A
part which has been thus immersed for a long time loses sensibility
to a great extent, is benumbed, and no longer feels the prick of a
needle as it did before immersion. Reflecting on these conside-
rations, I was induced to try the effect of cold water on a patient
who had previously undergone prolonged medical treatment, and
in whose case all the ordinary remedies had been used without pro-
curing rest.

" Several experiments made on healthy persons showed that cold
water of 35°— 40° Fahr. was too pahiful for continual application,
and water of 52° was found to be more suitable. For the continued
cold baths I made use of the water in one of my deepest wells, which
showed a constant temperature both winter and summer of 55°. In
summer the mere carrying of the water from the well to the bath
raised the temperature two degrees, and if it was allowed to stand
for a short time in the warm air it was raised much higher.

"The case which I subjected to treatment was a woman of thirty-
four years of age, who had fallen into melancholia after her first
childbed. While still labouring under the melancholia she became
pregnant again, and after an easy parturition she had a still more
severe attack than after the first. Two months after her confine-
ment she was placed under my medical care. Emaciated and deh-
cate as she was, there was still milk in her breasts, and she had been
nursing the child up to a few days previous. The skin was dry and
very hot, and the pulse rapid. Day and night without rest she
complained incessantly that everything was lost, and that she lived
no longer upon the earth but under it. She got no sleep either by
night or day, or at the most only for a few minutes, and then in
the sitting posture. A varicose ulcer which had broken out during
the first pregnancy was found on the right leg near the bottom of the
calf. Very thick veins extended in numerous folds and loops over
the whole right lower extremity up to the abdomen. The nose and
cheeks were of a bluish-red colour, which, on closer examination,
appeared to be due to the presence of small bluish vessels. She
was dirty, and passed her faeces and urine in any place and at any
time. To procure sleep, nourishing diet, rest, opium, and cold
applications to the head, with tepid baths, were tried for a long time
without any apparent result. At the end of the fourth month of
the treatment the condition was much the same as at the beginning;,
and I then determined to try the prolonged cold batL She was.

1867.] of Psychological Medicine. 99

with every care, and in my own presence, placed in the bath, and
the following conditions were noted : >

Date. Before Bath. After Bath of one hour.

July 15 . . .Temperature of water 56° Fahr 61° Fahr.

Temperature of patient —

Temple 84° „ 75° „

Axilla 93° „ 70° „

Hand 90^° „ 68° „

In the bath the patient became more and more tranquil; the
moaniDg abated ; the pulse at the wrist became almost imperceptible.
When chilliness came on she was taken out of the bath ; she then
obtained rest, alleviation, and one hour of sleep during the night.

Date. Before Bath. After Bath of two hours.

July 26 ...Temperature of water 59° Fahr. 64° Fahr.

Temperature of patient —

Temple 75° „ 72^° „

Axilla 90^° „ 8H° „.

Clavicular region ... 90^° „ 81^° „

'a i» •*' 11

Hand 86^° ., 79°

Was very restless during the day, sleepless, and no greater tran-
quiUity was produced by forty drops of tincture of opium. At the
end of the second hour the radial pulse could not be felt, and chill
set in. In the following night she had several hours of sleep.

Date. Before Bath. After Bath of two hours.

July 27 . . .Temperature of water 58i° Fahr 61° Fahr.

Temperature of patient —

Temple ....; 86° „ 79° „

Neck 93° „ 81^° „

Axilla 93° „ 79° „

Hand 94i° „ 79° „

Pulse before the bath 75, rather full; but after an hour and a
quarter not to be felt. The patient was restless during the day, but
ao longer destructive. Had good sleep at night, and kept herself
clean.

Date. Before Bath. After Bath of two hours.

July 28 . . .Temperature of water 67° Fahr 61° Fahr.

Temperature of patient —

Temple 86° „ 79° „

Neck 90i° „ 84°

*»

»»

Axilla 95° „ 84'

Hand 93° „ 75° „

After an hour in the bath the pulse sank from 90 to 56. The
restlessness then abated altogether, and for a moment she regained
complete self-possession. Towards the end of the bath chill came
on, on account of which the patient got out and was put to bed in

100 Report on the Progress [April,

warm bed-clothes. During the night she slept quietly. The dirtj
habits had ceased.

Date. Before Bath. After Bath of two hours.

July 30 ...Temperature of water 59° Fahr 62° Fahr.

Temperature of patient —

Temple 77° 75° „

Neck 90i° „ 8U° „

Axilla 93° „ 79°

» • "^ >»

Hand 90i° „ 75° ,.

Before the bath the pulse was 80, but during its administration
it became imperceptible. The night was again tranquil. About a
quarter of an hour after the bath a severe rigor came on^ but soon
passed off. *

Date. Before Bath. After Bath of two hours.

August 1 . . . Temperature of water 57° Fahr. 61° Fahr.

Temperature of patient —

Temple 88° „ 63^

Neck 93° „ 77° „

AxiUa 93° „ 76° „

Hand 90i° „ 73° „

The night was tranquil and passed in sleep. The varicose ulcer
began to heal. The day was also partially quiet, and the insanity
was hourly disappearing. The secretion from the skin was natural,
and the next day the perspiration was visible, which had not hitherto
been the case. A gradual tendency to recovery was unmistakeable.
She became quieter and more content. Although not completely
recovered, she left the institution on the 23rd of December, and on
the 20th of March next was quite well, as was stated in a letter
from her medical attendant, Dr. Besserer, of Duisburg.

" I adopted a similar treatment with a lady of twenty-two years
of age, who also suffered from melanchoUa agitans. It was, how-
ever, impossible to give her more than two baths. These were well
borne, and had a tranquillising effect. She slept better and was
more moderate in her moaning and quieter in her movements.

*' Such remarkable results of the lowering of the temperature,*'
Professor Albers concludes, ^^ demand further investigation. The
prolonged cold bath is without danger to the health of such patients,
and can only act beneficially. It appears, however, that they are
borne better in summer than in winter. My successful experiments
took place only in summer.*'

In a later number of the same volume of the * Zeitschrift' there
is a paper by Dr. Knkelnburg, Physician to the Water Cure Estab-
lishment at Qodesberg, entitled " Besearches concerning the Use
of Cold bathing among the Insane." He gives a more or less detailed
account of seventeen cases which were treated either by means of
the cold bath, or. cold ^'x)acking." Most of the cases occurred in

1867.] of Psychological Medicine. 101

the asylum at Siegburg, and all, with one exception, were examples
of recovery following the use of the bath.

According to the mode of administration practised in those cases
in which the bath was used the patient was placed suddenly by four
attendants into a large bath at a temperature of 60° Fahrenheit.
The bath was never prolonged beyond ten minutes. During this time
the head of the patient was from time to time submerged, the rest of
the body being allowed the greatest possible freedom. The author
considers the ten minutes' duration sufficient to prevent subsequent
excitement, and to diminish irritation in the nervous system. The
details of the cases are not given with the same minuteness as
in the instance reported by Professor Albers, the alterations in
the temperature of the patients not having been noted. In eight
cases the morbid condition is described as sympathetic irritation of
the brain, showing itself in the form of acute mania, with more or
less tendency to vascular erethism and to congestive affections;
one was a case of melancholia agitans. In most of the cases dis-
turbances of the sexual functions were regarded as either remote or
proximate causes. Considerable elevation of the temperature of the
body was observed in four cases. An almost constant result of the
bath was a calming of the action of the heart, with diminished fre-
quency of the pulse and lowering of the bodily heat. Among the
female patients increase of the catamenial function generally re-
sulted. In two of the cases, as well as in others not reported, rheu-
matic affections were brought on. In all the above cases complete
cure was eventually obtained.

The author gives an additional case of a young man of 27
years of age who suffered from acute mania of a rehgious character.
After three days of very violent excitement his aspect was pale and
dejected, the skin cool, the pulse above 100, and small. In the
evening he was placed in a cold bath for four minutes, after which
he was quieter, and put on his clothes himself, but complained of a
persistent chill. During the night he was apparently tranquil, but
while dressing in the morning he fell into convulsions, with loss of
consciousness, and contraction of the left pupil. He died comatose.
In the autopsy an extensive recent extravasation was found in the
arachnoid sac over the whole anterior part of the right hemisphere
of the brain, with dark discoloration of the grey matter. Of course
it cannot be stated with certainty that the unfortunate event was the
result of the bath ; but the circumstance is significant enough to
indicate the necessity of great caution in the use of the remedy.

The other seven cases are illustrations of the effect of the wet
sheet. Five were treated in Siegburg, one at Godesberg, and one at
Cologne. The usual mode of application seems to have been to
wrap the patient in the cold wet sheets and keep them on for periods
of two to three hours, or until perspiration occurred freely. Five

102 Report on the Progresa [April,

were cases of melancholia aud two of maniacal excitement, and in
all there was either complete recovery or such improvement as to
warrant discharge from the institutions. In one case of melancholia
accompanying enlargement of the uterus the use of the sheet was
followed by decided improvement. As this is the only case in which
the effect on the pnlse and the temperature is reported, we extract
the following table : —

Before the application. After one hour.

Temperature.

n
n

Pulse.

^ — '

Temperature.

Pulfle.

90 ...

... 66-8** Fahr.

86 ...

... 67-° „

86 ...

... 66-6° „

84 ...

... 66-4° „

90 ...

... 66-2° „

• 7o

84 ...

... 66-4° „

21 67r v»

22 67-1° i

24 67-3° „

„ 26 67-° „

„ 29 67-5° „

The temperature was taken by placing a delicate thermometer
under the tongue of the patient. It may be mentioned that in this
case the hip bath and the vaginal douche were also used.

A most important defect in Dr. Pinkelnburg's paper is the want
of all-information regarding the number of cases treated, or the
nature of the affection on which the bathing appeared to be inert or
injurious. It is evident that no reliable conclusion can be arrived
at in the absence of such data.

Mental Derangement produced by the Development of Echinococci
in the Brain, — Dr. J. Knoch, of St. Petersburg, controverts the
assertion of KUchenmeister, that hitherto the occurrence of Echino-
cocci in the human brain has never been ascertained with certainly.
He has had an opportunity of examining a preparation forty years old,
which was described by Eendtorf and Eudolplu as Echinococci, and he
has satisfied himself of the unquestionable correctness of their opinion.
He also describes an unmistakeable specimen which is preserved in the
Pathologico- Anatomical Institute in Berhn ; and he thinks there is
as little doubt about another which is described by Dr. Zeder in the
* Erster Nachtrag zu Goeze^s Naturgeschichte der Eingeweidewiirmer.'

Tabes doisalis and Paralysis universalis progressiva. — Dr. West-
phal, of Berlin, devotes a second paper to the examination of the cases
of the tabes dorsalis associated with mental derangement. A transla-
tion of the first paper by Dr. Rutherford was published in this
Journal (July, 1864, p. 207), and was intended to point out the re-
semblance between this disease and general paralysis of the insane.
The two affections resemble one another in the gradual weakening
of the mind, accompanied with grandiose delusions and maniac^
excitement, and also by the motor lesions of the lower extremities,
and the occurrence of epileptiform attacks. The two diseases differ.

1867.] . of P^eiological Medicifie. 103

however^ very decidedly^ in the order of their symptoms ; in tabes
dorsalis those in the lower extremities and in the bladder make their
appearance long, sometimes many years, before the mind is affected,
whereas this is never the case in general paralysis ; and the stagger-
ing when the eyes are shut is a symptom which is also absent
from the latter disease.

Since the first part of the memoir was published the patient
whose case is there recorded as third in order has died ; and the
post-mortem examination revealed the expected gelatinous degene-
ration of the posterior columns of the cord. It is important to
observe, however, that the pathological condition was not satisfac-
torily ascertained until the microscopic examination was made, an
instance of the importance which ought to be attached to this mode
of examination in all lesions of nervous structure. In this second
contribution Dr. Westphal has collected six additional cases illus-
trative of the association of tabes dorsalis with mental derangement,
which have been reported by Hoffman, Mannkopf, Joffe, and Meyer.
He believes that at least some of the cases given by Duchenne as
examples of what he has called Ataxie locomotrice, and of which,
unfortunately, no post-mortem examinations are reported, are really
cases of tabes. According to the course of the mental symptoms,
the cases divide themselves into two groups : in one, an exaltation
amounting to acute mania breaks out suddenly, exhibiting the
character of grandiose delirium ; in the other, there is gradually and
insidiously developed a general weakening of the intellect passing on
to the most extreme form of apathetic imbecility. In the first group
the weakening of the intellect makes its appearance in the more
advanced stage of the disease, and sometimes assumes a peculiar
periodic character. The author suggests that this peculiar course is
connected with hereditary predisposition, on which basis the disease
is developed.

On the Treatment of Melancholia with Opium. — ^Dr. Tigges, of the
asylum at Marsberg, gives a very careful report of thirty-nine cases
of melancholia in which opium was administered in greater or less
quantity. He has as far as possible avoided the disturbance of the
inferences to be drawn from his calculations, which would be caused
by administering the remedy, as has been frequently done in pub-
lished cases, when the patients were newly admitted to the asylum,
or otherwise placed in circumstances which might of themselves alter
the course of the disease.

The patients treated were 18 men and 21 women, of ages ranging
from 23 to 70 years; and the duration of the disease previous to
the administration of the remedy was from two months. The most
prominent symptoms were restlessness, destructive and suicidal ten-
dencies, and talking to themselves. The disease terminated in.

104} Report on the Progress [April,

recovery iu 13 cases; in improvement in 5; the condition was
doubtful in 5 ; apparently incurable in 12 ; and 4 died.

The opium was generally given in doses of from two to six grains
twice daily, and in one case the dose was as much as fifteen grains.
The periods during which it was administered were two weeks in 4
cases, one month in 9 cases, two months in 14 cases, three months
in 9 cases, and more than three months in 4 cases. In 2 of the cases
morphia was also given, and continued for several months, the
highest dose in each case being one grain.

The result of the treatment is reported as having been useful and
trauquillising in 14 cases ; it was prejudicial in 16 cases, the excite-
ment being increased ; in 2 cases digestion was interfered with ; and
in 7 cases no effect was produced. Among the 14 cases in which
the opium produced a beneficial result there was only one in which
the trauquillising effect passed on directly to recovery ; in all the
others where recovery took place that result did not appear to be in
any way due to the opium. Its action was purely symptomatic in
decreasing the intensity of the excitement, and in no degree affected
the progress of the disease. Indeed Dr. Tigges seemed inclined to
the belief that he attributes to the opium more credit than is due, in
saying that the tranquillity was in all these cases the effect of that
drug. In some of the cases the decrease in the intensity of the ex-
citement was very slight, and in others when the opium was stopped,
a continued or more decided tranquillity ensued, so that the improve-
ment perhaps took place in the natural course of the disease. When
the action was more evident it was not regular in its action, differing
in different cases, and capricious even in the same case. In one
case a comparatively small dose produced tranquillity, in another the
same dose had no effect, but a larger dose was effectual ; in another
the small dose was as useful as a large one ; in another the larger
doses were injurious, although smaller ones had been followed by
improvement. In one case the continuance of the doses which
at first had produced an effect ceased to do so, and even a
dose of fifteen grains produced no result. In another, the remedy
which at first had been beneficial became injurious in the same
doses.

The cases in which the opium seemed to act beneficially were
mostly characterised by considerable motor excitement. It is also
to be remarked that among the cases which terminated in recovery
opium exercised an injurious influence in 8, while the recoveries in
which opium had acted beneficially were only 4.

The author criticises the cases which have been published to prove
the usefulness of opium in this disease, and maintains that sufficient
care has not been taken to exclude those cases in which other cura-
tive influences have been at work. And he remarks with great
truth that statistics on this subject can never be estimated at their

1867.] of Psychological Medicine. 105

trae value until we are in possession of the statistics of the normal
uninfluenced duration of the morbid process.

An Instrument for determining difference in the size of the
Pupils. — ^Dr. P. Obemier, of Siegburg, describes a simple instru-
ment, which he has used for a considerable time^ and which he
believes to be of great use in this important observation. Jt con-
sists of two small oblong mirrors, which are fitted closely edge to
edge, and inclined to one another at an obtuse angle. These are
attached to a handle, so that they may conveniently be held oppo-
site the eyes which it is wished to compare. Owing to the diflferent
angles at which the mirrors meet the rays which are directed from
the eyes, a position can be ascertained by experiment at which one
half of each eye will be represented in each mirror close to the line
of junction of the two. By this means the mirrored half-images of
the two eyes can be brought into immediate juxtaposition, and the
diameter of each pupil accurately compared. Dr. Obernier reports
that the use of the instrument is easy.

On the Development of Grey Cerebral Substance as a new Forma-
lion in the fTalls of the Lateral Ventricles. — Only two such cases have
hitherto been satisfactorily reported; one mentioned by Virchow
('Gesamm. Abhandl.,' p. 998), and the other by Dr. Tungel
('Virchow^s Archiv,' vol. xvi, p. 166). Dr. Meschede describes in
this paper a very interesting case of what he calls " areolated hyper-
plasia.^' Michael Schattkowski, of Graudenz, a Pole, unmarried,
aet. 19, was admitted to the West Prussian Asylum at Schwetz, on
November 20th, 1863, suffering from epilepsy of many years'
standing, and idiotic imbecility which had existed from his earliest
childhood. His father had been a drunkard, and had hanged himself
four years previously. It is stated that in the second quarter of the
first year of his existence the cluld was suddenly, after a bath, seized
with an attack of trembling of the whole body and paralysis of the
tongue. It was only in his ninth year that he was able to pro-
nounce any words in an unmistakeable manner, but he never attained
any proficiency in the art. In intellectual capacity he remained
almost entirely wanting. Generally he was quiet in behaviour, but
sometimes easily made angry, when he would stamp and cry like a
child. Latterly the epileptic attacks had been becoming more
severe, and after his admission to the asylum their severity continued
to increase. In January 1864 he had nineteen fits in ten days ; in
February sixteen fits in two days. The last series was followed
by a comatose condition of several days' duration, but after recovery
from this the fits were less frequent, and weaker, and lost the con-
vulsive character. About the middle of May atonic diarrhoea and

106 Report on the Progress [April,

symptoms of pulmonary tuberculosis appeared, and gradually in-
creased until his death, on the 26th of June following.

The most important peculiarities in the condition of the brain, as
discovered at the post-mortem examination, were as follows : — On the
external superior and posterior walls of both lateral ventricles, stretch-
ing far back into the posterior comu, were a large number of round
or ovoid insulated masses of pale grey, yellowish-red, shining por-
tions of brain matter. Their size varied from one to ten miUi-
metres in diameter. Transverse section of the hemispheres showed
similar insulated masses of grey substance in the same neighbour-
hood, imbedded in the white substance. The surface of the hemi-
spheres was also characterised by nodular protuberances of larger
size, and instead of the usual regular appearance of the cortical layer
the grey matter was divided into insulated masses, between whii^
processes of medullary tissue were prolonged in a radiating mami^.
This peculiarity was most remarkable in the posterior lobes of the
cerebrum.

Hereditary Tendency in Insanity. — ^Dr. W. Jung, of TiCubus,
gives a very careful examination of the influence of previous genera-
tions on the mental condition of the population. His researches
are based on the history of 3606 cases which have been admitted to
the asylum at Leubus. The nature of the paper renders it unfit for
abridgment, but we may give the general results to which the exa-
mination leads him. According to the statistics, it appears that
when the father has been insane the sons who have become insane
have a greater predisposition to recovery than the daughters ; and
the converse holds when the mother has been insane. The father
shows a greater tendency to transmit insanity to the sons than to
the daughters ; and transversely, but in a greater degree, when the
mother is insane. The hereditary influence of the father is slightly
less than that of the mother. He also draws the following inferences
from the data before him : — 1. Women have a greater tendency to
be affected with hereditary insanity than men. 2. The most favor-
able opportunity for the outbreak of hereditary insanity is the period
of puberty in both men and women. 3. Among 1300 inhabitants
above the age of fifteen there is one insane ; and among four insane
there is one with hereditary predisposition. 4. The Protestant
population, compared with the Roman Catholic, gives a larger number
of insane and a greater number of relapses, but also the greatest
number of recoveries both from single and repeated attacks. 5. The
cases with hereditary predisposition show a more favorable propor-
tion of recoveries and deaths than those without hereditary predis-
position, and require shorter periods of treatment. 6. The cases with
hereditary predisposition show more relapses, but also a more favor-
able proportion of recoveries from them. 7. The cases with here-

1867.] of PsycAoloffical Medicine. 107

ditary predisposition otherwise follow the same laws as those without
such predisposition, especially as regards the greater curability of
women, in spite of their requiring on the average a longer period
of treatment.

Typhua among the Insane. — ^Dr. Wille communicates the results
of ms observation of two epidemics of typhus— one which he had
seen at the Goeppingen Asylum, and another which had occurred at
the asylum of MiinsterKngen since his removal to that institution. He
draws the following inferences from his investigation : 1. The symp-
tomatology of enteric typhus among the insane^does not essentially
differ from that of enteric typhus generally. It derives a character,
however, from the peculiarity of the individuals influencing the manner
in which the symptoms are manifested. In the incubation stage we
find exalted mental irritability which may amount to delusions of being
persecuted^ accompanied with a high degree of excitement ; and in
the further course of the disease we may have irregularities of the
circulation with differences between the rhythm of the pulses and
the dilatation of the arteries, and towards the end, only rarely, deli-
rium ; rather, on the contrary, the predominance of a deep apathetic and
soporose condition. 2. The diagnosis is more difficult on account
partly of the difficulty of obtaining information from the insane at
the commencement of the fever, which frequently make^ the exami-
nation of tiie patient and the objective investigation impossible, and
partly also from the existence of other mental and bodily morbid
conditions, as apoplectiform attacks in the course of general para-
lysis, the irritation stage of periodic and " circu W mental diseases,
mental conditions of irritation in the epileptic insane, and profuse
febrile diarrhoea in the course of secondary insanity. This last
difficulty is felt to the greatest extent in epidemics of typhus pre-
vailing in an asylum. 3. The prognosis in cases of insane persons
attacked with typhus is unfavorable. The sane are, indeed, more
liable to typhus, but the insane succumb more readily to the disease.
4. The influence of typhus upon the insane is only temporarily
favorable, and arises chiefly from the feeling of comfort produced
by the removal of a continued febrile condition. In exceptional
cases the insanity undergoes a permanent favorable change as a
consequence of the typhus. 5. The treatment should generally be
of a more tonic and stimulating character than in similar cases
among the sane. The nursing of the insane while labouring under
typhus presents special difficulty. The circumstances which exert
an unfavorable influence on the course of the fever are more difficult
to avoid, and the remedies which exert a favorable influence are
more difficult to apply. Especially in the apathetic stage there is
often absolute refusal of food, and instrumental alimentation be-
comes necessary. 6. In regard to sanitary arrangements he believes-

108 Report on the Progress [April,

that in all large asylums special rooms should be provided for the
reception of those sufifering from intercurrent bodily diseases, which
might be used for the separation of those suffering from typhus ;
their number should be in proportion to the number of inmates.
7. As regards prophylaxis, particular attention should be paid to the
condition of water-closets and drains.

A new System of Measuring the Head. — ^Dr. F. Obemier has
devised a more accurate mode of calculating the sizes of crania,
which he recommends instead of the somewhat unsatisfactory methods
hitherto employed ; but without the aid of a diagram it would be
difiScult, if not impossible, to give a satisfactory description of his
proposal.

A Contribution to the Subject of diminished Responsibility, — ^This
is an excellent paper by Flemming. It is difficult to present a
satisfactory abstract of it, but the following may be accepted as
an imperfect sketch.

If one proceeds on the incontrovertible supposition that the idea
of responsibility belongs to jurisprudence, it follows that the physi-
cian has nothing to do in psychologico-legal cases with the question
of responsibility or irresponsibility (Imputabilitat oder Nicht«
Imputabilitat),"^ but he has merely as an expert to ascertain the
facts and circumstances, and give an opinion thereon fromr which the
judge may infer the responsibility of the accused or the contrary.
These circumstances and these facts, which are the subject of inquiry
and consideration by the medical jurist, are connected with the ideas
of mental health or disease.

Mental health may be understood to include those vital conditions
in which the vital functions of the human organism are performed
in such a manner that whether it be normal or abnormal, they occa-
sion no manifest disturbance of the mental functions, — ^the intellec-
tual and emotional processes.

On the other hand, the idea of mental disease must be defined as
that vital condition in which evident and significant injuries and
derangements of the mental functions are conditional and called
forth by derangements in the corporeal system.

Hence there follow two considerations in establishing the exist-
ence of mental disease. In the first place, any irregularity in the
mental functions is not to be conceived of as mental disease, but
only such are to be regarded as are dependent on derangements of
the corporeal system. Hence it is an error to include moral degra-

* Though the literal meaning of the word used by Dr. Flemming—" Zurecb-
nungsfahigkeit"— is " imputability," I have translated it " responsibiUty/' as
bemg the word m general use in this country among those who have entered on
the controversy to which Dr. Flemmmg's paper is a contribution.— J. S,

1867.] of Psychological Medicine. 109

dation and like states in this idea^ though they may be maintained
to be abnonnalities of the mental processes. In the second place^
every abnormality of the corporeal system is not a manifestation and
proof of mental disease even where speech and action seem to indi-
cate injury to the mental processes, but only those corporeal anoma-
Ues can be received as proof of mental disease which exist in causa-
tive connection with the perceptible derangement of the processes.

Medical science, and more immediately the study of mental dis-
ease (psychiatry), affords an explanation of the causative connection
which exists between corporeal lesions and injury to the mental
functions. It is thus that we are taught to recognise mental disease
as such. If this science is not able in all cases to indicate the
manner of this causative connection between corporeal and intellec-
tual abnormalities, it supplies, in the exact observation of mental
diseases, the arguments by which this connection may be established.
These are obtained partly by the observation of the consecutive
order of corporeal and mental symptoms of disease which are ob-
served in unmistakeable mental disease, and partly by the observation
of such symptoms as are regularly or generally, and if not exclu-
sively yet chiefly, recognised in morbid mental conditions, and which
on this account can be regarded as their distinctive characteristics.
Hence it is requisite for the medical jurist, when forming a legal
opinion on doubtful conditions of the intellect and emotions, not
only to assure himself of the existence of sanity or insanity in each
case^ but also to set forth the arguments on which his decision
is founded. He should indicate and explain them to the judge as
clearly as possible, so that the latter may be put in a position to
appropriate to himself the decision of the physician, and to deduce
from the opinion presented by the expert the conclusions regarding
responsibility or irresponsibility. In so far as this deduction of the
physician is not arrived at, or (as the preliminary considerations
which are founded on medical science are inaccessible to the public),
may be unattainable, the judge will be obliged to rest his verdict on
the authority of a superarbitrium of the expert.

The ideas of health and disease in general are, however, de facto
only relative ; the vital conditions fluctuate between what is normal
and what is abnormal. These conceptions are only found in their
most assured condition where the characteristics of normal or ab-
normal vital conditions are exhibited in an easily recognisable
manner. From these extremes or poles towards the centre or in-
difference-point the characteristics disappear more and more, and
this indifference-point includes a certain but indeterminate extent
within which the existence of neither health nor disease can be ascer-
tained with certainty. We are, therefore, justified in recognising an
intermediate condition in which it is impossible to establish the ex-
istence of either health or disease. But we must not suppose that'

110 Report on the Progress [April,

this condition actually excludes the idea of health or disease, or
includes both. We must merely regard it theoretically, or for the
sake of argument, as belonging to either ; for it is only because we
are unable to decide to which it belongs that the idea can be adopted.
It must really be one or the other, although we are unable to make
the decision. The same considerations are applicable to mental
health and disease. They are only recognised with facility in their
extreme forms. Tliere are many mental conditions which have
certain characteristics of disturbance of the psychical functions de-
pending on abnormal physical conditions, to which, however, one is
not justified in denying the name of mental health. Hysterical and
hypochondriacal conditions may be mentioned as examples which
approach the character of mental disease without being actually re-
garded as such. On the other hand, there arie very extensive and,
at the same time, intense derangements of the mental functions along
with which some of the psychical processes appear to be carried on
in a perfectly normal manner. But though these manifestations of
healthy action bring the condition closer to what we regard as mental
health, we are not thereby justified in removing it from the category
of mental disease. These we regard, therefore, as doubtful mental
conditions, that is, doubtful in as far as it is not evident to which
extreme they belong.

While the extremes of mental health and disease are commonly
recognisable by those ignorant of medicine, this is by no means the
case as regards the intermediate mental conditions. In such con-
ditions as appear doubtful to the judge, he is accustomed to avail
himself of the opinion of medical experts. A portion of those
mental conditions which are obscure to the non-medical public are
not at all doubtful to the physician, who is familiar with insanity.
But there still remains a certain number regarding which the
opinions of the most experienced experts may differ, or which may
be even to them doubtful as to whether they should be classed as
sane or insane. And it may happen that the medical jurist, im-

f)elled by the desire to obtain a definite conclusion which he may
ay before the judge, may permit himself rather to give utterance to
a general impression than one founded on scientific knowledge, or
may wander into the misty region of metaphysics or transcendental
psychology, to which the judge has also access, and where things
run 80 much into one another that he may disagree with the
latter.

The question now is how the judge is to act in deducing from the
opinion of the medical jurist conclusions upon the sanity or insanity of
the person examined — whether he is to be looked upon as responsible
or irresponsible. It is evident that in those cases which are doubtful
to those ignorant of medicine, if the expert establishes the existence
of mental derangement, and makes it manifest that it depends on

1867.] of Psychological Medicine. Ill

existing lesion of the bodily system, the judge must decide on the
responsibility of the accused. In the same manner, when the phy-
sician is able to recognise the irregularities and apparent anomaUes
of the mental processes as not being the result of such morbid
physical conditions, and can find no signs characteristic of mental
diseiise, and consequently decides on the sanity of the accused, the
responsibility of the latter must be admitted. If, however, the
expert is unable to arrive at so satisfactory a conclusion; if the
characteristic signs of mental disease are not to be found, or the
existing anomalies of the mental processes are of so ambiguous a
character that they cannot with certainty be classified as symptoms
of mental disease, but may coexist with sanity — ^if remarkable
mental disturbance is found side by side with the normal operation
of the mental processes, so that grounds for directly opposite opinions
are present ; or, lastly, if the time favorable to the ascertaining of
the mental condition at the time of the event under consideration
has already past — in short, if the case remains doubtful also to the
expert, and his judgment either in one direction or another is sup-
ported by mere probabiUties, the certain foundation for the decision
of the judge is taken away.

In these circumstances there are two courses open to the judge
which require a critical examination from a medical point of view.
In the first place he may regard the condition of sanity as the
rale, and where no sufiBcient evidence of insanity as the exception
to the rule is apparent either to the public or to the expert, he may
decide on the responsibility of the accused. Against this view, how-
ever, there are several important objections. It is evident that one
cannot assert that a thing does not exist which is not demonstrated
or cannot be demonstrated. Por the means of demonstration may
have existed previously or may become evident afterwards, and thus
the error of the decision may be exposed. The injurious conse-
quences of such an error are apparent. The second course is indi-
cated by the consideration that if the conditions of sanity and in-
sanity upon which the responsibility or irresponsibility depends are not
separated from one another by a sharply-defined line, but gradually
run into one another, this must also be the case with responsibility
and irresponsibility. There will consequently be between the com-
plete responsibihty of sanity and the complete irresponsibility of
insanity an intermediate condition of diminished responsibility which
will rise and. fall according to the predominance of mental health
or disease. This solution also suffers from important defects. It
was shown above that in the '^ intermediate condition'^ the amount
of mental disease does not increase and diminish, but only the degree
of its manifestation, and that the boundaries of health and disease
are really sharp and well-defined. We ought, consequently, to have,
not a diminished responsibility , but a diminished capability of

112 Report on the Progress [April,

recognising responsibility. If one accepts the supposition of the
theoretical presence both of sanity and insanity in the intermediate
condition, we mast also accept the supposition of coexisting respon-
sibility and irresponsibility, which leaves the judge in the dilenmia
of having both to punish for the responsibility and to release on
account of the irresponsibility.

The duty of the medical jurist, however, consists in laying fully
before the judge not only his opinion but the grounds for it ; and in
cases which remain douotful to him let him not be afraid to give
utterance to the non liquet, but at the same time state the grounds
of probability and doubt for and against sanity and insanity.

Insanity in connection with Hydrocephalus, — According to the
observations of Albers, hydrocephalus intemus is associated with
two forms of imbecility. One is distinguished by restlessness and
frequently complete silliness (Narrheit), the other by deficiency of
mental power and paralysis (sometimes dumbness) . He finds also
that in the first or restless class, the water is collected in the visceral
sac of the arachnoid. In those connected with dumbness and para-
lysis, the collection of water was in the ventricles. In some cases
the two kinds of imbecility are mixed. In these the serous col-
lection is found in both situations.

Cretaceous Tumours {jSandgeschwulst) in the Insane. — Dr. Hipping
relates a case in which a tumour of this description about the size
of a cherry-stone was found in the left choroid plexus of a woman
who suffered at first from alternations of melancholia and mania,
which were followed by permanent delusional insanity.

Statistics of the Provincial Asylum for Curables and Incurables
at Halle. — Dr. Damerow gives a very full statement of the sta-
tistics of the Halle Asylum for the ten years ending December,
1863. The average number in the institution has been about 400,
those in the department for incurables being generally 100 more
than those in the department for curables. It would be impossible
in the space at our disposal to give any satisfactory resum/ oi the
learned author's remarks, and we must rest satisfied with noting one
or two of the more remarkable particulars from the opening of the
asylum.

The total number of admissions since the opening of the asylum
is 1,834 men and 935 women, or 2269 in all. Of these, 142 men
and 87 women were readmissions. The recoveries were 419 men
and 347 women, or 766 in all; those discharged improved were 151
men and 123 women, total 274. The deaths were 427 men and
177 women. Of the men who died, 125 suffered from dementia
paralytica; of the women, 22 suffered from that disease. There

1867.] i^ Pt^chohgical Medtciiu. 113

were 9 suicides Spread over 19 years. Of the admissions, 83 men
and 40 women were epileptic.

The classification pi the admissions according to their religions ■
beliefs, eshiliits what, at first sight is a curious result. . Calculating
the numbers in proportion to the total populatiou of each sect in
the province, there were admitted from

Among the Evangelicals 1 in eveiy 830.
„ Catholics 1 „ 1,769.
„ Jews 1 „ 11 8^.

But, as Dameiow remarks, there are so many circumstances be-
side the per-centage of insanity in the population which infiuence
these statistics that no deductions of any importance can be obtained
frofai them. The sect which has the largest proportion of poor
would be expected cat^rii paribui to send the largest proportion of
insane to a public asylum, even though the sect might not contain
s larger proportion of insane than the others. Some sects al^o have
modes of carmg for their poor whicH prevent them .from coming
tmon the public charge to the same estent as thej would otherwise.
For the whole statistics and a very interesting commentary we mait
refer to the original paper.

"^kf Presailiitg .Pr^udice agiaiiu( , He Insane.— An AddresB de-
livered before the General Assembly of Physicians and Naturalists
ia Kiel, by Professor Jessen, of Hornheim.

This is an appeal in favour of a more kindly manner of regarding
those suffering from insanity. The author exclaims emphatically
^inst what He believes to be still a common mistake— looking
npon the insane as criminals, or as being in a condition of which
ttej should be ashamed. He regards it as being, on the contrary, .
s condition of which the sufferers ought to be proud. "He who ■
lua no soul," says he, "has no. illness to fear, but whoever has been
endowed by nature^th a deep, rich and fertQe mental organization, .
beafs al^o the seeds, of illness m his inner man. Only the so-called
common-sense people, the cold heartless natures, devoid of every .
deeper feeling, are privileged to be invulnerable to mental disease.
- . . ... He. who can be made ill by mental emotion doubtless stands
Wgher than he for whom such impressions do not exist, or over whom
they pass transiently and leave no lasting trace." ■ He calls upon the
medical profession to exert themselves to remove the prejudice which
affixes a stigma to the idea of insanity. " I have conducted for
l*enty-five years na important aaylom-rthat erected inScbeswig in,
lS20j I. have bocome. acqiiaiuted with J5|0O, lunatics, and have
attended tbem proieBBiqnally ; I havclived.with and amongst tbem,
and have had more intercourse witt.^^ejn than* wi^h tbe,|¥^t of.. the
irorld. Should T pass an opinion as to the moral worth of these
VOL. xni. %

114 Report on the Progress [April,

persons, as compared with those who pass for sensible, I could only
do so in favour of the former. I acknowledge freely that I respect
the insane in general more than the rest of mankind, that I like
living amongst them, and that in their society I do not miss the
companionship of other people, and that I even find them in many
respects more natural and sensible than the rest of mankind/^

it may be hoped that Professor Jessen, having such sentiments,
will spend the remainder of his days among those whom he ap-
preciates so highly and loves so well.

II. — English Psychological Medicine.

By S. W. D. Williams, M.D., L.R.C.P.L., Assistant Medical
Officer of the Sussex Lunatic Asylum, Hayward's Heath.

Notes of Lectures on Insanity, delivered at St. Oeorg^s Hospital^
by Geo. Fielding Blandfoed, M.B. Oxon.

(Leotwre V. Melancholia — Mania. Lecture VI, Chneral Paralyaie — Definition

of Insanity. Conclusion,)

In the October number for 1866 of this Journal, we gave a brief
risumi of four lectures on Insanity, delivered at St. George's
Hospital by Dr. George Fielding Blandford, and published in the
' Medical l^es and Gazette.' Since then, two more lectures, con-
cluding the course, have appeared.

In Lecture V, Dr. Blandford proceeds to consider those patients
of whose insanity there is no doubt, who require medical care and
treatment. Putting aside all chronic and incurable cases, he
roughly divides the recent and primary into those characterised by
great depression of feeling with corresponding delusions — ^in other
words, melancholia — and those marked by the exaltation of gaiety, or
fury, or ambition, or by the frenzy of delirium, comprised under
the generic name of Mania,

" Probably,'' truly remarks Dr. Blandford, " the most curable and
the most frequent of all forms of insanity is slight non-acute melan-
cholia, which shows itself, first of all, by a restless depression, and
passes through various stages of despondency, until, from being
simply low-spirited and fanciful, the patient's fears assume another
shape, and become definite delusions, which are almost invariably of
a most distressing nature, and often prompt to suicide. With this
mental state, symptoms of a physical nature appear: "the tongue,
as a rule, will be coated, creamy, and foul mdth old epithelium,
producing great foetor of breath, the whole being often the result

1867.] of Psychological Medicine. 115

of starvation ; the pulse is quick and weak, the bowels are con-
stipated/^ &c. These symptoms Dr. Blandford considers to be due
to the mental symptoms; but in this dictum many will disagree
with him, rather believing them to be prior to, if not the cause of,
the mental alienation, as would seem to be proved by the undoubted
fact that an abatement and finally the disappearance of the physical
symptoms is always a precursor of amelioration of the psychical
phenomena. These cases, as already remarked, generally get well,
often without the necessity of sequestration in an asylum. Medicine
here, says Dr. Blandford, can do much : enemata of castor-oil and tur-
pentine, than which there is no surer remedy, will remove the hardened
scybalse that block the bowels ; bark, quinine, iron, stimulants,
good solid nutritious food, to restore tone to the constitution ; and,
finally, some preparation of opium — of which preference is given to
the bimeconate of morphia, as causing less sickness and constipation
than any other — to ''procure sleep and allay the ever-present panic/'
And with the medical should be combined a judicious moral treat-
ment, including cheerful companions and plenty of light amusement.
These cases do not, however, always progress so favorably, but at
times pass ''into a state of excited terror and panic, which may
fitly be called acute melancholia/' This disease is of a most dis-
tressing and unfavorable nature, and frequently arises at the close
of some chronic or wasting disease, such as phthisis, in patients whose
constitution is broken down, and who have no power to withstand
it. Patients suflfering from this variety of acute melanchoUa almost
invariably refuse their food with the most obstinate tenacity, says
Dr. Blandford: and he proceeds to enumerate the various means
and modes of forced alimentation, for which he seems to have a
decided partiality. He says, "Every asylum doctor has his favorite
method of forced alimentation;" which is, however, scarcely the
fact, as many now-a-days deny altogether either the use, efficacy, or
necessity for it, rather believing it to be a remnant of the rapidly
exploding restraint system. In some asylums, it is true, we hear
of the stomach-pump or nasal tube being used daily at each meal-
time on a greater or lesser number ; but, in others, such a thing is
totally unknown. Whence this discrepancy ? Are we to suppose
that in the one case it is used unnecessarily, or that in the other
the patient is left to die ? Is it not rather probable that the more
you use the stomach-pump, the more you may, and that refusal of
food treated by forced alimentation in one case in an asylum is
very apt to produce an epidemic of such cases ? especially as it is
usnially the young assistant medical officer who has to force the
alimentation, and the patients requiring such treatment will be
usually found amongst the young hysterical females. It was Mr.
Commissioner Browne who, I beUeve, once wrote that no patient
should ever be forced with food until, if of the male sex, the matron

116 Report on lie Progress [April,

had exhausl^d all efforts to coax him to eat ; or, if a female, until
the assirtAnt medical officer had tried all his powers of persnaisioii.
Dr. Blandford next proceeds to consider Mania, and writes^ —

" The primary forms of mania — for I do not speak of the chronic forms of
this or any other kind of insanity — are at least three in number. There is
the complet« delirium of true aciite mania, d^lire aigue of the French ; there
is the- noisy, violent, but conscious mania, sometimes called acute ; and
th^re is the- quiet, oivderly insanity with delusions, called by some mortomanur,
by others partial insanity. Acute mania or acute delirium usually comes on
very rapidly in persons under, rather than over, middle age, who are in the
height of strength and vigour. The premonitory symptoms will vary
much ; but after great restlessness and excitement of manner, with sleep-
leasnesa and probably pain in the head^ the outburst may suddenly occur
with, or without definite delusions. There will at first be intervals of com-
parative calm, till at last the storm breaks out, probably in the night-time.
Then begins a period of raving unconscious delirium, with singing, shouting,
and laughing, an incessant strain of incoherent talk, and perhaps perpetual
motion of the limbs. The patient will not stay in bed, will not Keep any
clothes on, is wet and dirty ; but he is not dangerous, and is only violent
when opposed. Tet he must be placed where he cannot come to any harm.
His room must be. rendered safe, whether it be an asylum or not, for
mechanical restraint must not be used here ; it can only serve to exhaust
the patient and prolong the attack. Such cases get well suddenly, recovering
very rapidly when tlie delirium ceases, and may be quite well in a month,
or even less, but they must be carefully tended while in the delirious stage.
They require an empty room, dark, cool, and airy, with bed on the ground ;
and their clothes must be fastened so that they cannot strip them ofit They
do not, as a rule, re^se their food, though they are whimsical and require
coa;Kingf. sometimes! rejecting it, sometimes eating ravenously.

Dr. Blandford's suggestions as to the treatmcDt of these cases
appear -to. us to-be, on the whole, most valuable. He asks. What
is the medical treatment of such a case? and trnly answers; Very
little so far as dmgs are concerned. It has become the fashion
now-a-days, on the idea that seclusion is part of the restraint system,
to -decry its use altogether ; and we Jfind, in the annual asylum
reports of some asylum, self-laudatory remarks on the total, or
almost totals abolition of sedusion in such asylum. But, to our
experience, nothing is so necessary to a patient suffering from acat6
mania as^ total seclusion, and nothing so likely to cause the acute
mania to degenerate into chronic mania as allowing a patient
labouring under the former disease to associate with the extemsd
world of an ordinary lunatic ward.

**Thefe is," writes Dr. Blandford, "another form of mania, sometimes called
'acute,' charaeterised, not by deKrium, but by noisy violence ai\d outri^eous
mischief. It does not, as a rules, ooibe on so suddenly as the la^t, but ^uually
developes till it reaches this stage. Nothing but an asylum will restrain or'
cure suoh a patient, for he is perfectly conscious, and with all the wits at
bis command taxes the temper and the ingenuity of those who have the care
of hikn^ His health appears tolerably ^ood'; he sleeps oGcasiohally, perhaps
by day* and naakes night hideous with singing Or shriddng. He wi}l destrojr

f.- •: .• Wf ■ - '. n ••■ • • ■■ •' r -rt I . •;.

•- i.

1867.] of Psychological Medicine. 117

. , • . ■ • . '. . •...

everything he can — clothes, furniture, bedding. He will be wet and dirty
not firom unconsciousness, but from ptire love of causing trouble. Such
patients try the temper and patienoe of aU who hare to do with them ; they
will go on for months in this state, and then get well or quiet down inta a
more orderly form of o(iania, or from continual* excitement and want t)f
sleep they may sink and die of exhaustion. These are the cases in which
extended and prolonged muscular exercise has been recommen<led, and is
of great service. In acute delirium this, I need not say, & out of the
question^ bat in this subacute or noisy conscious mania^'it will divert the
normal bodily activity and procure a grefiter amount > of sleep. It is here,
also, that such drugs as tartar emetic, digitalis, and hydrocyanic acid afe
useful ; opiates will not avail much, but the others will often allay the great
excitement, and make a man more rational and obedient. For these know
and understand perfectly what is said to them, and require to be treated
with great firmness as well as kindness. - Pre-eminently they' demand moral
control ; their amouf prepre^ their self>respeet, must be stimulated; A man
m acute delirium, under an^ kind of moral treatment t; ma^ regain co!l-
sciousness and recover his right mind ; but these patients, ' tinder rough
hands, may d^enerate ittto dementia or chronic insanity. They will eat
heartily^ and requure plenty of food. The medicines I' have mentioned
must TO, carefully administered and closely Watched; and of the three pro-
bably diffitalis is the most useful, not in heroic dosev of half an ounce, but
in safer doses of half « drachm. There ibay belittle to discover in the ^y
of delusion in such, their' insanity being t^hieflr displaced in action. On the
otlier hand, they may be fttU of delusions ana haliucmations, in which case
the proffnosia is less favorable, especilally if the attack be prolonged. This
kind of violent mania without marked delusions is in women often denomi-
nated hysteriotU matUai. Mid it may last a v^y short dra* very long time,
vaiying from a few days to months; and an analogous forni often occurs in
youns men who are nervous or weakly, or given to self-abuse. This may
ran Its course in a few days, presenting all the appearance of a violent
hysterical attack.*'

Dr. 31aiidford describes monomania as mania characterised^, not
by excitement, but simpjy by delusions ; and when th^ patienjb acts
orderly and tranquilly, and can talk rationally on other points, it is
often \/sraMQA partial insanity. Such insanity is usually chronic and
the termination of a more acute attack^ thpUjg^ without this some
drift by dqgrees into the condition of delusion/ When such de-
lusions have appeared . recently, and are traceable to some given
cause, they may possibly be gc^ rid of by change of scene, by the
substitution of other employments and ideas, a^d .similar appropriate
treatment. But wkere, they have /been, apparently without any
caused evolved out of the disordered ideas of the ,b]'ai^,.and when
they remain imd persist, immutable and, inexplicable, they form,
perhaps, the most incurable of all the varieties en insanity. In such
GBfies the absence of necessity for immediate treatn^ient frequently
ca^ifjes.il^ to, be postponed till the time is past and the disease is
chipiucimd ineradicable. ^ ^ .. ^ i > w. - :. ^ <u

Dr. Blandford next consid^s- (Lecture YI) -D^^^^;^, whi<ib he
defines tq be/ an ^^tmnihilated intellect,-^ a decay of the faculty of
ideation,' so that ideas are not retained in the mind, or have no

118 Report on the Progress [April,

connection one with the other. Chronic dementia he passes by in
a few words, and proceeds to acute dementia, which he distinguishes
from Baillarger^s mSlancholie avec stupeury by an absence of
depression, by the history of the very earliest symptoms, and by
the absence of suicidal attempts and suicidal refusal of food. The
prognosis of this disease he considers to be eminently favorable;
and as it usually occurs in persons ^' frail and delicate, with a weak
and sensitive nervous organisation,'^ medical treatment does much
for them. The older the patient, says Dr. Blandford, the less
favorable the prognosis and the greater probability of the super-
vention of chronic dementia : —

" What is the treatment of such cases, and where is it to be carried out ?
An asylum is not absolutely necessary for them. The proper treatment can
be applied as well in an ordinary house and family, though it can hardly be
at home. They are for the most part passive rather than active patients.
They require much stimulation and nutrition, which shall raise their
prostrate nervous power and excite it without exhausting it. Plenty of
food and stimulants will be requisite ; brandy and wine — above all, warmth.
Warmth which to others would be excessive and depressing, will barely
suffice to raise their circulation to an ordinary level ; warm rooms, warm
baths, and warm clothing will all assist, as well as the warmth brought about
by exercise. Cold shower-baths are often of great service, given as stimu-
lants, not as depressants, for thirty or forty seconds, and followed by
continued friction till the surface is warm. Tonic medicines, too, are
valuable, as quinine and steel, and small stimulating doses of morphia. If
the bowels are inactive, the mildest purgatives will suffice, as castor-oil or
confection of senna. The catamenia will at first be absent in most cases ;
but this, after a time, will right itself, and meddling in this direction will
do more harm than good. In the majority of cases such treatment will be
successful.*'

Dr. Blandford then briefly sketches the symptoms of general
paralysis of the insane, remarking, inter alia, that, as a rule, man is
its chief victim, and that, although in the county asylums there are
always some few female general paralytics to be found, perhaps in
the proportion of 15 to 50 males, in the asylums for the better
classes you may search in vain for a lady affected with general
paralysis. Reviewing the pathology of general paralysis, he speaks
favorably of the recent researches of Dr. Franz Meschede, contained
in a paper published in Virchow's 'Archives,^ 1865; an abstract
of which, however. Dr. Blandford published in the last October
number of this Journal.

Dr. Blandford concludes his course with the following words :—

" Such, gentlemen, are the chief varieties of insanity which it is expedient
— ^nay, necessary — to bear in mind, either for diagnosis, prognosis, or treat-
ment. Infinite subdivisions may be and have been made, for, in truth, as
no two persons are alike in mind, so are no two alike in the method of their
madness. And this applies equally to another subject, which, for the same
reason, is as difficult as the classification — I allude to the definition of

1867.] of Psychological Medicine. 119

insanity. Can we define it—^can we do more than describe? Must our
definition be of that negative kind which logicians tell us is no definition at
all ? Looking at these various forms of unsoundness of mind — at idiocy, at
insanity with and without delusion, at instinctive and transitory insanity, at
primary or secondary dementia — what can we say the disorder is ? It is
evidenced, as I stated, by what is said or done. This is the result ; but if
we keep in view the analysis of mind and mental processes laid down in
the first lecture, we may, I think, arrive at a conception of what insanity is.
It is a want of co- ordination j of harmonious action of the two functions of the
brain, commonly called feeling and intellect, a state either congenital or produced
by disease, by which want of harmony true volition is distorted or destroyed.
The intellect may be defective, idiotic, or full of delusions, leading to acts
devoid of intelligence or prompted by deluded ideas ; or the intellect may
remain clear, but blind and uncontrollable feeling may force a person to
sudden and unaccountable action. Wherever the defect may be, the true
harmony and co-operation of the two functions are suspended or lost. Hence
true volition, which results from this perfect harmony, is interrupted, and
insanity, an irresponsible and faulty mental condition, is the consequence.
It were useless to recite the definitions of various authors, or to point out
their defects. None can be perfect, for all must partake more or less of a
negative character, inasmuch as insanity is the negative of sound mind.
With one suggestion I take leave of the subject — avoia attempts at definition
when you are in the witness-box.

•*I now bring these brief 'Notes' to a conclusion. There are very many
topics which I am compelled to pass over. On one or two I hope some day
to say a few words."

An Accounl of a Second Case in which the Corpus Callosum was
defective. By J. Langdon H. Down, M.D. Lond., Assistant-
Physiciau to, and Lecturer on Materia Medica at, the London
Hospital ; Physician to the Asylum for Idiots, Earlswood.

Dr. Langdon Down, in the forty-fourth volume of the ' Trans-
actions of the Medico-Chirurgical Society,^ published an account of
a case in which the corpus callosum was defective. Another in-
stance of this " rare abnormality^' having come under his notice, he
describes it to the same Society in the following words :

A. B — came under my observation in the autumn of 1858. He was the
son of a clergyman, and had been submitted to the ordinary process of edu-
cation with out trifling results. He had been taught to write a little, but
he never exercised the art. He had learned to read easy words, and could
answer simple questions. His power of calculation was almost nil. He
was fond of music, had slight power of imitation, and his memory, although
defective, was good in relation to persons and things. He was five feet four
and three quarter inches in height, and weighed ten stone one pound. His
trunk was well formed, and his facial expression that of an imbecile. He
was shy, undemonstrative, fond of children (some of whom he petted), while
towards persons of his own age and to the opposite sex he was violent and
passionate. His friends were very desirous of asserting the non-congenital
nature of the mental condition, and attributed it. to masturbation. The
diaghofiiis formed, however, was'th^t it was congenital, and that the mas-

120 Report on the J^rogress [Ap^

•

turbation was an accidental circumstance. This diagnosis was strengthened
by reference to the other members of the fkraily, tirhoj although occupying
good positions in the world, were manifestly not of average intellectutd
power. The habit of masturbation became entirely broken, and he gave
himself iip to simple employments^ such as wheeling invalids in a Bath ctiair,
and otherwise aiding those whom he petted.

He 'lived to forty years of age, when he died of pleuro-pneumonia. An
autopsy was made thirty hours aftefr death. The' circumference of the head
wasitwenty-^one and a quarter inched; the bilateral curve, eleven and a half
inchea; the antero-posterior curve, twelve inches ; the bilateral diameter,
five and eight-tentha inches ; the antero-posterior diameter, six and sev<^n-
tenths: inchlss. Tlie calvarium was unsymm^trical and dense, shelving lin-
teriorly^ the posterior clinoid processes were converted into sharp neecHe-
like points ; the encephalon weighed two ]x>und8 fourteen ounces. On sepa-
: rating the two hemispheres, the almost entire absence of the corpus callosum
I was Apparent, and the velum interpositum exposed to view. A small carti-
laginous-like band, seven twenty-fourths of an inch in breadth and one
twenty-fourth of an inch in thickness, situated opposite the corpora striata,
was the only representative of the great commissure. The fornix Was
represented by two thin posterior pillars ; the body of the fornix and its
anterior pillars were abs«rit. The right optic thalamus was very mubh
larger than the left. The cineritious portion of the brain was pale, the pos-
terior cornua ofithe lateral ventricles were distended with straw-coloured
serum, and the Pineal gland was the size of a wild cherry. The ntiiddle
commissure was absent. The rarity of this abnormality may be indicated
by the <:irouinstanoe that it is only the second time I have met with it in the
dissection of 150 brains of idiots." '

Marriages of Consanguinity in relation to Degeneration of Race.

By J. Langdon H. Down, M.D. Lond.

(Clinical Lectures and Reports, London Hospital.)

Whbtheb marriages of consanguinity do produce, to the extent

usually supposed, degeneration of race, Dr. Down considers a

doubtful point. It is true, he says, that Duvay, of Lyons, asserts

'Hhat in pure consanguanity> isolated from all circumstances of

hereditary disease, resides, vpsefactOy a principle of organic vitiation ;''

but in antithesis to this he places the assertion of Dr. Gilbert Child,

that ^' the marriages of blood-relations have no tendency, per se, to

Jlrodticfe degeneration bf race.^'

♦

"My notes refer," says Dr. Down, " to 1 138 cases of idiots, 7^8 being males
and 386 females, which I may say^ en passant , h about the ratio, according
to my experience, in which the sexes are affected by idioc^, viz., in the pro-
portion of'about two to one.

; /* I'have taken' the- records with every care as to accuracy, and from the
number, have excluded all cases in which' therd #^ imi^ossibility in obtaining
information, or eleQietfts of doubt when obtained:

*^InflHeuced only by these circumstanced, I have eliminated 196 males and
90 females, leavine 557 males and 295 fein^les, or a total of 85^, on which
the arguments will be based.
A** (M'lthe 759 male idiots, 33 were the progeny of first cousins ; in two of

1867.] of Psychological Medicine. 121

these instances, there. was, another element elicited, viz., in one case the
mother was also. |h& product of first cousins, and in the other the mother
was the product of cousins-germain, involving, therefore, in these two cases,
an increased intensity of bluod-relationship. . Three cases were the progeny
of second cousins, four pf third cousins. In all, 40 cases out of 753, or
only rather more than 5 per cent., could by any possibility have been due
to consanguineous unions. Of the 295 females* 13 were the progeny of first
cousins, 3 were the children of second and 4 those of third cousins. In all,
20 among 295, or little less than 7 per cent., could have been caused by the
marriage of blood-relatious.

^' The difference in ^he per-c^ntage of idiots,the progeny of cousins, between
the male and female, sex is remarkable, but may, I think, be explained by
the existence of a preponderating cause of idiocy on the part of males over
females, in the larger size of the male cranium at birth, and the consequent
greater risk of injury to the cranial contents during parturition.

« I am unable to speak with certainty how frequently the marriage of blood-
relations takes place in fin ordinary community, but I have made a careful
inquiry into the family . history of 200 persons who are sane and healthy,
collected from different districts, and who belong to different families, and I
find only one was the offspring of cousins, being \ per cent. ; and I learn
that in that one instance he is the sou of unusuuly healthy parents. Cer-
tainly, in his case th^re is no symptom of either physical or mental dege-
neracy, and he would probably be selected from among the 200 as one of the
most robust and vigorous."

Then, liaving related several cases. Dr. Down proceeds to com-
pare his statistics with those of Dr. Howe, U.S., on the same sub-
ject. Dr. Howe^s 17 marriages produced 95 children, 46 per cent,
of whom were idiots. Dr. Pown's 20 .marriages produced 138
children, only 18 per cent, of whom were idiots. And in contrast
to these, he takes 20 other marriages, in which there was no con-
sanguinity, producing 145 children, 18 per cent, being idiots. The
great reason of the discrepancy between Dr. Howe^s statistics and
his own. Dr. Down believes to be due to the fact that, of the con-
consanguineous progeny on which his data are founded, 55 per cent,
vere of average health, whereas only 39 per cent, of Dr. Howe^s
could be placed under that category.

Observations on an Ethnic Classification of Idiots. By J. Langdon

H. Down, M.D. Lond.

(Gtinical Lectures and Reports, London Hospital.)

I have for some tjrne, writer Br. Pown, had my attention directed to the
possibility of ip^^Ling a classification of the feeble-minded, by arranging them
around viuriou^ ethnic 9tandtu^49 — in other words, framing a natural system
to supplement the information to be derived by an inquiry into the history

of the qase.

I IfAYe been f^ble to $(id i^mqng the large number of idiots and imbeciles
wluph 9pm^Vo4QT Vkj observation, both at £arbwood and the out-patient
lipitrtment of the hospital, that a considerable portion can be fairly referred

122 Report on the ProgreM [April,

to one of the great divisions of the human family other than the class
from which they have sprung. Of course, there are numerous repre-
sentations ot the great Caucasian family. Several well-marked examples of
the Ethiopian variety have come under my notice, presenting the charac-
teristic malar bones, the prominent eyes, the puffy lips, and retreating chin.
The woolly hair has also been present, although not always black, nor has
the skin acquired piormentary deposit. They have been specimens of whit«
negroes, although of European descent.

Some arrange themselves around the Malay variety, and present in their
soft, black, curling hair, their prominent upper jaws and capacious mouth,
types of the family which people the South Sea Islands. Nor have there
been wanting the analogues of the people who, with shortened foreheads,
prominent cheeks, deep-set eyes, and slightly apish nose, origually inhabited
the American Continent.

The great Mongolian family has numerous representatives, and it is to
this division I wish, in this paper, to call special attention. A very large
number of congenital idiots are typical Mongols. So marked is this, that
when placed side by side, it is difficult to believe that the specimens com-
pared are not children of the same parents.

'J'he number of idiots who arrange themselves around the Mongolian type
is so great, and they present such a close resemblance to one another in
mental power, that I shall describe an idiot member of this racial division,
selected from the large number that have fallen under my observation : —

The hair is not black, as in the real Mongol, but of a brownish colour,
straight and scanty. The face is flat and broad, and destitute of promi-
nence. The cheeks are roundish, and extended laterally. The eyes are
obliquely placed, and the internal canthi more than normally distant from
one another. The palpebral fissure is very narrow. The forehead is
wrinkled transversely, from the constant assistance which the levatores pal-
pebrarum derive from the occipito-frontalis muscle in the opening of the
eyes. The lips are large and thick, with transverse fissures. The tongue is
long, thick, and is much roughened. The nose is small. The skin has a
slight dirty -yellowish tinge, and is deficient in elasticity, giving the appear-
ance of being too large for the body.

The boy's aspect is such, that it is difficult to realise that he is the child of
Europeans ; but so frequently are these characters presented, that there can
be no doubt that these ethnic features are the result of degeneration.

The Mongolian type of idiocy occurs in more than 10 per cent, of the
cases which are presented to me. They are always congenital idiots, and
never result from accidents after uterine life. They are, for the most part,
instances of degeneracy arising from tuberculosis in the parents. They are
cases which very much repay judicious treatment. They require highly
azotized food, with a considerable amount of oleaginous material. They
have considerable power of imitation, even bordering on being mimics.
They are humorous, and a lively sense of the ridiculous often colours their
mimicry. This faculty of imitation may be cultivated to a very great ex-
tent, and a practical direction given to the results obtained. They are
usuallv able to speak ; the speech is thick and indistinct, but may be im-
proved very greatlv by a well-directed scheme of tongue gymnastics. The
co-ordinating faculty is abnormal, but not so defective that it cannot be
greatly strengthened. By systematic training, considerable manipulative
power may be obtained.

The circulation is feeble ; and whatever advance is made intellectually in
the summer, some amount of retrogression may be expected in the winter.
Their mental and physical capabilities are, in fact, directly as the tempera-
ture.

1867.] of Psychological Medicine. 123

The improvement which training effects in them is greatly in escess of
what would be predicated if one did not know the characteristics of the
type. The life expectancy, however, is far below the average, and the ten-
dency is to the tuberculosis which I believe to be the hereditary origin of
the degeneracy.

Apart from the practical bea/mg of this attempt at an ethnic classification,
considerable philosr>phical interest attaches to it. The tendency in the pre-
sent day is to reject the opinion that the various races are merely varieties
of the human family having a common origin, and to insist that climatic or
other influences are sufficient to account for the difierent types of man.
Here, however, we have examples of retrogression, or at all events, of de-
parture from one type and the assumption of the characteristics of another.

If these ereat racial divisions are fixed and definite, how comes it that
disease is able to break down the barrier, and to simulate so closely the
features of the members of another division P I cannot but think that the
observations which I have recorded are* indications that the dififerences in
the races are not specific, but variable.

These examples of the result of degeneracy among mankind appear to me
to furnish some arguments in favour of the unity of the human species.

&U Marys Hospital, Case of Peculiar Delirium after Fever ;
witA Clinical Remarks, By Dr. Handfield Jones, F.E.8.

(' British Medical Journal.')

In the 'British Medical Journar for January 12th appears a
case of peculiar delirium after fever, by Dr. Handfield Jones, which
we append in extenso, as well as a letter from Dr. Lockhart Eobert-
8on which appeared in the same journal for the following week.

B. S — , female, set. 12, was admitted March 1st, 1866. She had recently
passed through a severe fever, in which she was highly delirious, requiring
two or three persons to restrain her ; and her hair had been cut aS, She
was very emaciated. A fit occurred the following day. When I saw her
on March 9th, I was struck by her appearance as she lay in bed. Her
manner was excited ; her face had a determined but rather wild expression.
She used the most foul and abusive language to me as I stood by her side,
repeating the same thing or question again and again, in a loud, earnest,
insisting voice. She had been in the same delirious state ever since she
came in, and tried sometimes to get out of bed. She passed all her urine,
and often her stools, in bed — and always would, if not watched. The
motions appeared very healthy. Her appetite was very good indeed ; she
ate ravenously. She had not slept at all well until last night. The fore-
head was warm ; pupils large ; tongue clean ; she put it out when asked.
She was better all the morning until about 1 p.m. Pulse 105, weakish,
■harp ; heart's sounds normal, action sharp. Her mother seemed to be a
very respectable woman. At times, the nurse said, she behaved as nicely
•8 possible — spoke properly, and thanked her for her care. She took half an
ounce of quinine mixture three times a day, and four ounces of port wine.
She had till yesterday two ounces of brandy.

March 12th. — She was quieter; had been replaced in the large ward.
She became excited at times; looked intently and eagerly at me, with a
fixed gaze, as I stood by her bed; Uxdc my hand and tried to remove the

] 24 Report on the Progress [April,

ring, but did not speak. A bottle of stout and' six ounces of port were
ordered.

16th. — She was much better, more rational, not abusive now at all. Hpr
mental faculties were by no means jet in their normal state, but she was
easily controlled when spoken to.

19th. — She was quite quiet and well-behaved ; still very ema<?iated. Urine
of specific gravity, 1023, not albuminous; deposited lithates and some
mucus.

26th. — The skin was cold ; pulse very feeble. Slie was much better ;
quite calm and rational, but had still a peculiar eager gaze. She took ordi-
nary diet and one egg^ and slept very well.

Clinical remarks by Dr. Jonks. — This case was under the care of Dr.
Alderson, to whose kindness I am indebted for permission to use it. The
history suggests various considerations of much interest. The brain, we are
sure, must have been ill-nourished, showing in this respect the condition of
the body. Moreover, the fever-poison had affected it specially, as declared
by the previous severe delirium. Its condition was one of prostration ai^d
excitement, well described, I think, by the term " hypersestbesia." It may
aid us in forming a better conception of this morbid cerebral affection, if we
compare it, as' I believe we may very correctly, with hyperesthesia of a sen-
sory nerve.- In the latter, the nerve-power is not truly increased; it is
essentially a state of weakness ; and in its causation, as well as its cure, is
closely related to neuralgia and anaesthesia. Its affinity to such a state of
cerebral disorder as I have above described is well exhibited by the following
highly interesting instance, which occurred in the practice of Dr. H. Green-
h(5w, to whom I am indebted for the account : — A young man, convalescent
from severe tjrphoid fever, had hypersesthesia of the legs, and subsequently
maniacal delirium, during which tne hypersesthesia disappeared, but returned
again with ereat intensity as the delirium ceased in twelve days under the
use of morphia. Here it seems quite reasonable to believe that the patho-
logical condition of the peripheral nervous tissue, and of the cerebral, was
very similar, if not identical. What is the exact modification which the
neurine undergoes, we shall probably never ascertain ; nor does it [seem
very important to do so, as long as we know what sort of change it is, whfit
causes give rise to it, what state of vital power it betokens, and what treat-
ment removes it. The occurrence of an epileptiform fit may be accounted
for on the view that the hypersesthesia extended from the hemispheres to
the excitable districts. It is worth remarking, that there were no bed-sores,
thoujgh the emaciation was very great. This indicates a considerable vitality
of the skin. The internal tegument also preserved its vital endowments
well, as shown by the capacity to take and digest food eiSectually. Herein
Dr. Alderson's case contrasts favorably with one Which I recorded lately
(M. 6.) where the powers of the stomach were greatly impaired, and there
was frequent sickness and loathing of food. " ^vttiin^ avTivparrowris Kevta
fravro," savs HippocrateA. I am sure it is so when the stomach proves dere-
lict to its duty.

Mania after Fever,

Letter from C. Lookhast Robebtson, M.D.

Sir, — With reference to Mr. Handfield Jones's interesting c^se of miuiU
followinff fever, and to his clinicfd renisurks, reported in the ' British M^jc^l
Jdurnal of January Ii2{H, it may Be of interest to your readers to compare

1867.] of Psychological Medicine, 125

these with the annexed passage, which I translate from Professor Griesinger's
'Systematic Treatise on Mental Diseases.' I am, &c.,

C. LocKHART Robertson.
Hay ward's Heath ; .

January, 1867.

" Acute febrile diseases of different kinds occasionally give rise to an out-
break of insanity ; the disorders which they occasion within the organism
seem to be the only causes of the insanity. Typhus fever, intermittent fever,
cholera^ the acute exanthemata, pneumonia, and acute rheumatism, are the
diseases in which it occurs most frequently. In regard to the latter, the
facts are as yet little known and studied : we shall here give this remarkable
caase of mental disorders the consideration which it deserves.

'* After typhus fever, and as well after a slight as after a severe attack, it
is not at ail rare to see a slight degree of mental disorder which may be
placed in the same category with the slight affections of other parts of the
nervous system — incomplete anaesthesia, transient paralysis of the extremi-
ties, &c. The patient, now quite free from fever, or even become con-
valescent, retains either some fragments of his former delirium, or he
exhibits, independently of this, all kinds of perversities — erroneous ideas on
various subjects, sometimes even in regard to himself; also hallucinations,
vith nervous exhaustion and weakness, without profound excitation of senti-
ment. This form of mental disturbance, this species of fragmentary deli-
rium, admits of an altogether favorable prognosis, and almost always disap-
pears rapidlj when the nutrition is improved and the strength increased,
even though, as sometimes occurs, a certain degree of maniacal excitement
be associated with it. But there are also much more severe cases of true
chronic insanity which commence during convalescence from ^phus fever,
or can at least be traced to this and to its slow commencement. Melancholia,
which gradually increases; occasionally it is accompanied with stupor —
sometimes with ideas of poisoning, refusal of food, early intermixture of
symptoms of mental weakness, ana transition to mania and profound de-
mentia : such is the ordinary course of those cases in which recovery of the
cerebral functions does not take place, which perhaps depend on permanent
disturbances of nutrition of the brain ; but, at all events, the prognosis is,
ttcording to experience, always unfavorable."*

• " Those who have written upon typhus fever — for example, Chomel, Louis
(ii, p. 83, 2nd ed*), Simon (' Joomal des Gonnais. Med.-Chir.,' AoM, 1844, p. 53),
Sanret (* AnnaL M^d-PsychoL/ 1845, vi, p. 223), Leudet (ibid., 1850, p. 148),
Tbore (ibid.* p. 596), Schlager ('Oesterr. Zeitschrifb fiir prakt. Heilk.,* 1857,
83-T-35), Tiingel 'Klinische MittheUungen,' .Hamburg, 1860, p. 18)— have also
eommunicated cases of this description. Jacobi, in one eighth of his cases of
mania, ascribes the disease to the consequences of typhus fever : it appears to me
▼erj doubtful, however, whether this has always been true typhus. Schlager
fomid amongst five hundred mentally diseased, twenty-two cases which could be
traced to ty^us fever. I cannot indorse the opinion that the foundation of these
cases is to be sought in the hypersemia of the brain which remains after typhus
fever ; all point rather to states of ansemia and exhaustion, occasionally even with
remnants of the fever. In exceptional cases, these diseases may be caused by the
presence of sanguineous clots in the sinus of the dura mater, perhaps by menin-
gitis, or by acntd atrophy of the brain.''

126 Beport on the Progress [April,

On Insanity and the Criminal JResponsihility of the Insane. By
Thomas More Madden, M.E.I.A, &c. &c.

{Meeul before the Medical Society of the College of Physicians in Ireland.)

In the course of this interesting paper occur the following remarks:

'* Instead of the numerous terms used to describe the rarious types and
forms of insanity — and which seem to me, although, doubtless, of value to
the psychological physician, calculated rather to embarrass and perplex,
than to aid the medical witness in courts of law — I would renture to
suggest that, for medico-legal purposes, unsoundness of mind, not including
mental deBciency or idiocy, should be divided into the two classes, only, of
general and partial insanity — the latter being the only one in which medical
evidence is needed in cases of crime ascribed to insanity.

"A madman is, it may be presumed, one in whom the faculties, or any
one of them, which should regulate and point out his relations and be-
haviour towards God, his neighbour, or himself, are either lost or impaired
by disease.

"Obviously, such a person cannot be considered as either morally or
legally responsible for his actions. For to be responsible for an act, it is
essential that the person committing it should possess liberty of will as well
as of action, which a lunatic does not enjoy, or he would be none.

'* But besides the state of mind in which a man is responsible for his act-s —
or sanity, and that condition in which he is not accountable for them — or
insanity — there is a third condition of mind in no way provided for by our
law, and which seems not sufficiently recognised even by the medical
profession. I allude to what Baron von Feuchtersleben terms * a state of
half freedom ;' that is, a state of transition between the healthy and
unsound mind, either preceding or following insanity. In this state, the
patient is only partially able to exercise self-control, and therefore is but
partially responsible for his fictions. This peculiar condition of mind should
be recognised by law in this country, as it is in France, where, on a jury
bringing in a verdict of *FIus innocent que coupable,' the Avocat-G^n6ral
may order an investigation into the state of mind of the prisoner, and award
a punishment in proportion to the real guilt of the accused.

" However, although insanity is too often punished as crime ; on the other
hand, crime sometimes shelters itself under the discruise of insanity. For
my part, I am not one of those who share Lord Hale*s opinion, that 'all
crime is the result of partial insanity ;' a dogma which appears to me not
only subversive of the principles of all religion and dangerous to society,
but at variance with common sense.

**Mere passion is not madness. Nor should any, so-called, irresistible
impulse, not connected with a diseased brain, nor any emotion or custom
which is not of itself a proof of insanity, be considered as conferring
immunity from the just punishment of crime. None are free from passions
or impulses, which, if they be not checked, may become almost irresistible
from habit, and may lead to crime. But, in such cases, the perpetrators of
crimes being accountable for the acts by which the control over the passions
was originally weakened, they are equally accountable for all the con-
sequences that may arise therefrom. A madman is not thus responsible,
not being answerable for the diseased action in his brain whence the insane
act proceeds.

]S67.] of Psychological Medicine. 127

"The law of England, as laid down by the judges in their reply to the
queries of the House of Lords on this subject, is — that if the perpetrator of
an action is capable of distinguishing right from wrong at the time he
committed it, he is legally responsible for it, even though he may be
partially insane. The following are the words of this decision : —

"1st. 'Notwithstanding that the party committing a wrong act, when
labouring under the idea of redressing a supposed grievance or injury, or
under the impression of obtaining some public or private beneBt, he was
liable to punishment.

" 2nd. ' That before a plea of insanity should be allowed, undoubted
evidence ought to be adduced that the accused was of diseased mind, and
that at the time he committed the act he was not conscious of right or

wrong Every person was supposed to know what the law was,

and therefore nothing could justify a wrong act, except it was clearly proved
the party did not know right from wrong. If that was not satisfactorily
proved, the accused was liable to punishment.'

" The 3rd question was not answered, and as it was purely legal need not
be quoted.

^' 4th. ' The judges were unanimous of opinion, that if the delusion was .
only partial, that the party accused was equally liable with the person of
sane mind. If the accused killed another in self-defence, he would be
entitled to an acquittal ; but if committed for any supposed injury, he
vould then be liable to the punishment awarded by the laws for his
crime.* ' "

On tie Two Types of Ancient British Skulls, By John Thurnam,
M.D., Medical Superintendent, Wilts County Asylum.

(' Medical Times and Gazette.*)

The following appeared in the form of a letter in a late number
of the 'Medical Times and Gazette' : —

"In the review of Mr. Pike's valuable work, 'The English and their
Origin,' in your number of the 23rd inst. (p. 206), the writer, adverting to
tbe cranial conformation of the ancient Britons, ventures on a statement so
remote from the fact, that I feel called upon to make a few observations in
regard to it. The passage to which I refer is as follows : —

" • The theory promulgated by Dr. Thurnam, that in certain long barrows
long skulls are invariabfy found, whereas in short barrows short skulls are
found, apart from the a priori impossibility which such a bizarre classification
appears to carry on its very face, has been proved to be altogether baseless.*
" So far from this being the cas*», the researches which 1 have been able
to make during the last two years, and since my former memoir on this
subject was published, in not less than ten or twelve long barrows of this
part of Wiltshire, have produced eighteen additional skulls which show
no exception whatever to the formula, which holds good for this part of
England, of ' long barrows, long skulls.' It may be asserted, without fear
of contradiction, that in no case whatever has a short, or brachycephalous,
skull been yet found in the primary interments in any long barrow.
On the contrary, the skulls which are found in them are very remarkable
for their long and narrow form — such, indeed, as at the present day no longer

* ' Hansard's Parliamentary Debates/ 1843.

128' Report on the Progress of Psychological Medicine. [April,

exist in Europe, and is equalled only in the crania of Ne^oes, Hindoos, or
Melanesian islanders. As regards the round barrdws and round skulls, I
was irell aware that the connection between the two was far from being so
uniform as that between the long barrows and long skulls. But, notwith-
standing some facts which show an admixture of the two types of skull, long
and shorty in the circular barrows, it may still be asserted, as is done even
by Dr. Barnard Davis, that in the primary interments in this form of
tumulus the prevailing cranial type is short and brachycephalic.

*'More important than the connection between the form of the skull and
the form of tne barrow (which is, of course, altogether accidental, and may
be, and no doubt is, reversed in different countries, or even in different
parts of the same country), is that which I believe may be regarded as
established between the form of the skull and the relative date, or chro-
nological sequence, of the two classes of tumuli in which they are (bund.
I cannot here give the proofs in detail, but there is every reason for
believing that the long barrows are the most ancient sepulchral monuments
of this part of Europe ; and as no object of metal has in any well-authen-
ticated instance been found in them, whilst those of stone and bone have so
been found, they niay clearly be referred to the Stone Age. The circular
barrows, on the other hand, may be shown to be the latest of our pre-Roman
British tombs, and not only yield objects of ;stone, but in many cases those
of metal (bronze) also. They belong to thef Bronze Age, which here, as in
most other countries, succeeded to that of Stone. It Would thus seem that-
the long-headed race, by whom the long: barrows were erected, were at the
first in sole occupation of the island ; and that succeeding to and encroaching
upon them came a short- or round-headed race, who raised round barrows
over their dead, and by whom, or in whose time, bronze appears to have
been introduced. It is not, however, probable, or in accordance with what
usually obtains under like circumstances, that the entire racie of long-heads
w'ks extirpated by the new-comers ; and thus the remains of both races may
be looked for in the circular barrows; though, as a rule, those of the
conquering and dominant one will be found to prevail, and are especially
met with in the more honorable — primary or central — place of interment.

'* It will be seen that, equally with the writer of this review, I admit 'the
co-existence of the two types * of skull, a dolichocephalic and brachycephalic
onOj among the ancieint firitons ; but thai; I differ from him in denying that
two such different forms can by possibility belong to otie and the same'
'typical ancient British skull.' These two statements are iti fact incom-
patible and mutually destructive. What we actually find are two distinct
types among ancient British skulls which, in respect to the cerebral portion
of the cranium, differ from each other, on an average, almost or quite as
much as do the skulls of Slavonians and African Negtoes.

" I need scarcely refer to the distinguished anthropologists, both of this
country and the continent, by whom my views on this question have been,
more or less, adopted and indorsed, but may, perhaps, be excused for naming
M. P. Broca and Professor Huxley. It appeal^ to me that, Whilst it
was open to the r^iewer to have stated that the results I liad arrived at
required confirmation from other and independent researches, it was hardly
so to assert that they have been 'proved to be altogether baseless." '

'* I have embodied the facts colltected, during the additional excavations
of the last two' years, in a paper recently communicated to the Anthro-
pological Society of London, and which, I understand, will be read at the"
meeting on Tuesday next, March 5."

129 [April,

PART IV.-NOTES AND NEWS.

I^ Lunacy Commissioners and the Surgical Home for Women.

Letter from Chasles P. Phillips, Esq.

Sin, — The Commissioners in Lunacy having observed in the Times of
the 15th ultimo a paragraph relating to the London Surgical Home, it
became their duty to communicate upon the subject of it with the founder
and Senior Surgeon of that institution.

I forward herewith a copy of the correspondence. As the matter is of
considerable public importance, the Commissioners hope that you will be able
to give the letters a place in your Journal. I am, &c.

Charles Palmer Phillips, Secretary,

Office of Coouilisaioners in Lunacy, 19, Whitehall Place, S. W. ;

January 23rd, 1867.

Office of Commissioners in Lunacy, 19, Whitehall Place, S.W. ;

January 8rd, 1867.

Sir, — ^I am directed to transmit for your] perusal the enclosed copy of a
paragraph which appeared in the Timei newspaper of the 15th ultimo; and
to inform you that the House- Surgeon of the London Surgical Home, having
attended a meeting of this Board on Monday last to explain that paragraph,
tben substantially admitted to the Commissioners present the reception into
tbe Home of females of unsound mind.

The Commissioners will now be glad to hear from yourself, as Senior
Surf^eon of the Home, whether there is any and what mistake in the
paragraph, or on the part of the House- Surgeon, as to the objects of the
Home ; and, if any mistake has arisen, whether you have taken, or intend
immediately to take, any and what steps to disabuse the public mind upon
the subject of this apparent violation of the Lunacy Law.

I am. Sir, your obedient servant,

Charles Palmer Phillips, Secretary,

L Baxbb Bbowk, Esq.

[The paragraph in the Times newspaper above referred to, and in that
newspaper headed '* The London Surgical Home,'' contained the following
passaee : ^ A peculiar feature of the Home is, that, in addition to the ordinary
maladies which come under the head of surgical diseases, women are received
who are of unsound mind, provided that their infirmities are not hereditary
or of a long duration previous to their application for admission. In it the
great experiment is being made for the first time of endeavouring to cure
mental diseases by surgical operations."]

186, Barley Street, Cavendish Square, W. ;
January 5tb, 1867.

Sir, — In answer to your communication dated the 3rd inst., I beg to state
that the article in the Times newspaper to which you refer was written by a
gentleman, a perfect stranger to me, who came on the pfP^'t of the Tmss
newspaper, was shown over the Home and supplied with all the papers by

VOL. xin. ^

180 Notes and News. [April,

the Secretary ; and I never saw tbe article until it appeared in print the
next morning. I was very much vexed at the mistake therein, and
instantly took such steps to ensure correction as I thought would be
sufficient. I have been daily waiting to see my hopes realised, and am now
most willing to take any steps the Commissioners may advise to di>abuse the
public mind upon the subject of any apparent violation of the Lunacy Law.

I shall be very happy to wait upon the Commissioners to offer any further
explanation, if they think it necessary. I remain, &c.,

I. B. Bbown.

Ohableb Pauoeb Phillips, Esq,

Office of Commissioners in Lunacy, 19, Whitehall Place, S. W. ;

January 8th, 1867.

Sir, — The Commissioners, observing with pleasure your sense of the

Kavity of the mistake in the Times* article of the 15th ultimo upon the
»ndon Surgical Home, direct me to acknowledge their receipt of your
letter of the 5th inst., and at once to obtain from yourself, as Senior Surgeon
of that institution, a plain and direct contradiction of its being open for the
reception of females of unsound mind. The Commissioners doubt not that,
in possession of such an authoritative contradiction, they will be able them-
selves to procure for it that necessary publicity which you have hitherto
failed to get. I am, &e.,

Charles Palmer Phillips, Secretary.
L Baxeb Bbowk, Esq.,

The London Surgical Home.

186, Harley Street, Cavendish Square, W. ;
January 10th, 1867.

Sir, — I have no hesitation at once in stating, as Senior Surgeon and
founder of the London Surgical Home, that the institution is not open for
the reception of females of unsound mind, and in no papers or advertise-
ments issued or published by authority has it ever been stated so. During

last year, one patient, a servant of , was taken in as suffering from

hysteria. I immediately discovered she was of unsound mind, and, as quickly
as possible, had her removed to Hanwell Asylum. I am, &c.,

I. B. Brown.
Charles Palmer Phillips, Esq.

Mr. Baker Brown must feel highly favoured that a special reporter should have
been detpaiched from Printing House Square to describe his institution. We
presume, however^ that the statement made in the report was furnished to that
gentleman by some one officially connected with the Heme. The profession will
take note of Mr. Brown* s announcement , that no patient of unsound mind has
been cured of the disorder by clitoridectomy, in the Surgical Home. It was
understood that such cures were the striking proofs of the efficacy of that
procedure,* — British Medical Journal^ January 26th.

• Surgery eor Lttnatics.— In the painixil and; disgusting case of Hancock
V. Peaty, the advocate, Dr. Spinks, stated that the unfortunate lunatic had been
placed under the care of Mr. Baker Brown, who, " unknown to her husband, had
performed a most cruel, and he m'ght say barbarous, operation upon her." As
this is one of the great experiments for the cure of mental diseases by surgical
operation to which the * Times,' on unknown authority, alluded, and which Mr.
Baker Brown so promptly confounded his house-surgeon by repudiating, so far as
his Home is concerned, when interrogated by the Lunacy Commissioners, the
statement of Dr. Spinki is not without importiuice. Mr. Peaty himself is reported -

1867.] Notei and News. 131

Dr. Kitching on the Gheel Question.

Closely connected with the question of the personal liberty and the social
enjoyment of the lunatic patient, is a subject which has engaged considerable
attention of late under the name of the Cottage System of treating lunatics.
In the well-known colony of Gheel in Belgium, this plan has been exten-
sively practised, and the ideas which underlie the experiment are based upon
much that is sound and valuable. They may be enumerated as follows : —
1. The view of placing the patient in sane society. 2. That of training him
to some industrial pursuit, and giving him an abundance of fresh air. 3.
That of allowing him more perscmal liberty and a nearer approximation to
the ordinary modes of social life than he could have in an asylum. Notwith-
standing the plausibility of these views, the plan as carried out at Gheel is
acknowledged by some of the best judges to have failed in producing the
full benefits anticipated from it.

Its failure was inevitable, as plans founded on wrong principles must sooner
or later always be. Whilst seeking to avoid the evils of large establishments^
it ran into the opposite extreme of individual treatment— a mode of treatment
the least adapted to many forms of lunacy, even in their chronic stage. The
lunatic cannot, in an isolated condition, be supplied with all that he requires,
on account of the expense of providing it. The treatment must therefore
be an associate treatment, except in the case of wealthy persons. Unless
the sane persons amongst whom the lunatic is cast in such an arrangement
as that at Gheel be adapted by the possession of sound judgment and
humane motives for rightly influencing the patients, it is evident they must
commit errors of the gravest import to the welfare of the latter. The society
of sane persons is doubtless a desideratum in the treatment of insane indi-
viduals ; but to have a beneficial influence in promoting their recovery, the
associates of the insane must possess qualities which the rustics of a village
cannot indiscriminately claim. It is often feared that the mutual association
of insane persons must have a reciprocally injurious influence, and this is
often stated as a drawback to sending patients to lunatic establishments.
There are cases in which the action of one insane patient upon another is
pernicious, but the influence of a sane mind without discrimination and
judgment may be much more so. To this I believe all concerned in the
management of the insane will readily assent.

The industrial training which forms a prominent feature in the Gheel plan,
can be quite as well carried on in a large lunatic asylum, and in the latter is
much less liable to be monotonous and influenced by sordid motives than in
the cottage of the artizan. The third idea, that of less restraint and of ex-
emption from the crowd- force and routine of a large establishment, is only of
weight as regards a certain proportion of the insane. In most acute, and all
violent cases either of mania or melancholia, the associate action of an esta-
blishment, and the moral influence of its power, are of the highest value ;
means of treatment are also possessed which cannot exist in private dwell-
ings. These views, however, are fully consistent with the belief, that for a

in the ' Daily Teleg^ph' to have stated in evidence, ** I never gave the smallest
sanction to her being taken to Mr. Baker Brown's establishment, and I am even
now in the dark as to what the operation was that was performed upon ber. I
wrote a most passionate letter to her sister, complaining of her being subjected to
such barbarous treatment.'' We have the best authority for stating that the
above statements have engaged the attention of the Lunacy Com.missioner8.--t
J3n^it4 Jfei(K(Mi(2Jb«r»a2» February 2nd.

ISi^ Notei and News, [Aprit

portion of the insane, the regulations of a large asylum, the pressure of
numbers, and the adaptations for the severer forms of mental disease to
which all the inmates must in some degree be subject, are not necessary and
are not beneficial; but that, on the contrary, they oppress the mind and
form conditions, if not unfavorable to recovery, at least productive of much
Unprofitable discomfort. For these the possession of more personal liberty,
the enjoyment of more social advantages and a more home-like mode of lire,
are conditions, for depriving them of which no moral or psychological reason
exists. There are three classes of patients to whom I think this statement
applies.

First — Those patients whose mental impairment consists in the milder
forms of melancholia, of moral or of emotional insanity, which, while they
deprive them of the faculty of entire self-government, and unfit them for the
l*esponsibilities and, more or less, for the pursuits of life, neither destroy the
reasoning powers, deaden the sensibilities, nor introduce any element of
danger into the outer or inner life.

Second — Those chronic cases in which some harmless, fixed delusion, the
residuum of a more pervading active form of insanity, co-exists with much
power of general self-regulation and an intelligent appreciation of the con-
cerns and interests of ordinary life. Decided intellectual tastes, and love
for literarv or scientific pursuits, often accompany this stage of insanity,
and are cultivated with pleasure and success.

Third — Those patients who are liable to occasional or periodical attacks of
acute disorder, but who have long intervals of partial sanity. In some of
these cases, the lucid intervals are apparently complete ; but to the skilled
observer, there is an arrest of convalescence at a sufiicient distance from
complete sanity to deter the physician from subjecting the patient, during
any portion of the interval, to the difficulty and hazard of self-government,
and entire freedom from surveillance and control. The writer has for many
years entertained the opinion that for patients affected, like those above
specified, with the lighter forms of insanity, who retain a large measure of
mental and moral capacity, a position in which they might have medical
advice and skilled surveillance, whilst enjoying a larger range of personal
liberty and social intercourse than is possible with the all-embracing arrange-
ments and uniformity inevitable in a large establishment, would not only
diminish the sufferings attendant upon insanity in the aggregate, but form
an advance in its treatment which claims to be tried at the earliest period
that it can be carried into effect.

It is difficult to trace the origin of our ideas. To me these views appear
to have risen up as the result of long observation and careful consideration
of the different kinds and degrees of insanity, with their various claims,
Capacities, and sensibilities. They have, however, deepened and gathered
strength during the last few years. Views of a similar tendency, in
some instances going much bevond mine, have been expressed by several of
the leading psychologists of the day. In some of the county asylums they
have been partially carried out by the erection of separate buildings in the
grounds of the establishment or in the neighbourhood, and their use as
dwellings for patients on the footing of small social or family parties. This
l^an was adopted by Dr. Bucknill at Exminster, and by Dr. Robertson at
Hayward's Heath. Recently, on the female side of the Colney Hatch Asylum,
a detached building, having the appearance of a large ordinary dwelling-
house, has been thus appropriated to the residence of about thirty femfSe
patients. It goes by the name of " The Home," and the energetic matron,
under whose auspices this project has been chiefly carried out, assured the
writer that it is an object of ardent aspiration with the patients to be allowed
to form a member of the party at " The Home." These movements iDToIve

1867.] Notes and News. 183

ft question of genend application, and have in view the introduction of an
improyement in the mode of treating certain classes of insane patients — an
improvement which the writer believes is gaining ground in the minds of the
most thoughtful psychologists, and to which the advancing intelligence and
humanity of the age are tending. The permanent sequestration of all kinds
and degrees of insanity in one promiscuous asylum or hospital, will probably
be regar«led, in the course of a few years, in the light of an anomaly.

The asylum plan of treatment is based, in the present state of legal and
practical psychiatry, upon a theoretical uniformity which makes no distinction
between the more profound and the lighter forms of insanity, or between one
stage of insanity and another. It is allowed on all hands that for the former,
the associate treatment and provisions of a large establishment are needful
for their safety, and best adapted for their cure. For the latter, who form a
not inconsiderable proportion of the ins&ne, the proposition here advanced is
that the present asylum plan is not required. The cases included in
this class of mental infirmity require separation from their friends and
special treatment — but for them a beneficial alteration of the present asylum
plan might be made.

Great as are the improvements in the treatment of the insane already
secured, and in securing which the Retreat has had no small share, these
improvements have not reached the ne plus ultra. The direction in which
further advances are to be sought, is in the way of a provision by which the
barrier separating the world of insanity from that of the sane shall be
reduced to its least practicable dimensions; in other words, b^ which the
nearest possible approximation may be attained in the life, habits, pursuits,
enjoyments, and social condition of the insane to those of sane society. — The
Smniieik Report of the Friends* Retreat near Fork, 1866.

Tke Metropolitan Poor Bill,

The object of the Metropolitan Poor Bill, then, is to separate the manage-
ment of the sick and impotent poor from that of the other classes claiming
parochial relief. With this view, it proposes to give the Poor-Law Board
powers to divide the metropolis into a number of districts, in each of which
separate asylums shall be erected, as the Board shall from time to time deem
necessanr, for the care and treatment of the lunatic and imbecile poor, of
those afflicted with fever or smallpox, and of those labouring under other
forms of disease. The funds for the erection of these establishments it is
proposed to raise by a general rate on the whole metropolis; but their
management will be confided to local boards, one of which will be provided
for each district. For the maintenance of the asylums it is proposed to
follow a somewhat different system. Those for the insane, and for the fever
and smallpox patients, will be supported from the general metropolitan
fund ; while the bulk of the expenses of those for the ordinary sick will fall on
the parishes from which the patients are sent. The boards of management
will be formed from the ratepayers of the several districts, and will consist
of elective and nominated managers — the former to be appointed by the
guardians of the parishes forming the district from among themselves, and
irom the ratepayers assessed to the poor-rate on an annual value not less
than £100; and the latter to be named by the Poor-law Board from among
justices of the peace resident in, and assessed to the poor-rate of, the district,
on a similar annual value. The number of nominated managers is not to
exceed one third of the prescribed number of elective managers ; but the
total number to be elected, their qualifications, and their tenure of oflice,
are from time to time to be fixed by the Poor-law Board. The fitting- tip

134 Notes and News. [April,

and furnishing of the asylums, and the provision of medical and surgical
appliances and other requisites, are likewise to be determined by the Poor-
law Board, who are further to regulate the mode of admission of the
patients.

It will be seen from these details that this bill meditates most material
innovations in the administration of the Poor-law. Of its general object,
we most cordially approve ; nevertheless, we cannot help regarding with
some apprehension several of its special provisions. And, first, we are
inclined to doubt the propriety of throwing the maintenance of the insane
and the fever and smallpox patients on the general metropolitan fund. The
reason for this proposal lies apparently in the conviction that insanity, fever,
and smallpox are not likely tu become sources of imposition, and that there
is a necessity for separating the patients affected with these diseases from the
rest of the community : but, granting this, we would nevertheless submit
that if the maintenance of the insane poor is thrown upon the general fund,
the result will be a speedy and enormous increase in their numbers. So long
as the maintenance of the pauper insane fulls upon their individual parishes,
the ingenuity of the parochial medical officers is taxed to show that many
forms of insanity and idiocy are but slight constitutional imperfections
which do not fall within the statutory definition of lunacy; but once let it
be made the interest of the parishes to regard all their weak-minded paupers
as lunatics, and tlie parochial medical officers will soon acquire anew light on
the subject, and certify accordingly. This danger should be guarded against,
as well as that which will ensue from making the admission of patients into
the proposed asylums too mucli a matter of course. In all probability, these
hospitals will not be regarded by the poorer classes in the same light as the
workhouse infirmaries : of necessity they will not possess the same deterrent
character \ and they will thus be more readily resorted to by petty tradesmen
and others who ought not to come within the scope of the Poor-law. It will
be necessary, therefore, to take precautions against utterly destroying the
independent feelings of these classes of the community. When, in ordinary
circumstances, a necessity arises for charitable aid, it does not necessarily
follow that the whole burden of the pauper's maintenance should be under-
taken by his parish. An allowance of two or three shillings a week may be
all that is necessary ; and even in the case of sickness, where the patient is
treated at home, part of his maintenance is still as a rule defrayed by him-
self. Could effect not be given to the same principle, and the patient be
made to contribute according; to his means, altliousrh recourse were had to
asylum treatment r We must always bear in mind that, although the disease
may not be simulated, the necessity to have recourse to public charity may
be, and that it is therefore proper not to diminish too much the immediate
interest to detect imposition. But if the bill goes too fur in widening the
area of chargeability for insane and fever patients, it seems to us to err on
the other side by narrowing too much the field for the maintenance of the
ordinary sick, by throwing it on their respective parishes. In our opinion,
a better course would be to make the area of chargeability in all cases co-
extensive with the districts. This would tend to equalise the burdens with-
out too much diminishing the check on unnecessary expenditure. A general
fund, raised by assessing a population of three millions, will be too likely to
be regarded as a fair field for plunder; whereas a rate borne by perhaps a
tenth part of this population will still convey the impression of individual
contrbution and individual respimsibility.

But the most objectionable feature of the bill, we think, is the unconsti-
tutional authority which it vests in the Poor-law Board. To this body power
IS given to make and unmake districts, to determine what asylums shall be
provided, to fix the number of managers and nominate that third which is

JLb67.J Note^ and News. 185

non-electiye, to regulate the mode of admission of patients, and to prescribe
what furniture, fixtures, and conveniences shall be provided. These powers
are of so extensive a character, that they should be clearly defined by statute,
and hot left to the discretion of a board which may possibly use them in a
crotchety and despotic manner. The Legislature has already seen fit to
withdraw, in a great measure, the treatment of the insane poor from the
Poor-law authorities, and to vest it in bodies specialty constituted for the
purpose. But these bodies — called asylum visitors in England, and district
boards in Scotland — are elected in the former country from the Justices, and
in the latter from the Commissioners of Supply, in accordance with distinct
statutory provisions. With them rests the right, subject simply to the
approval of the Commissioners in Lunacy, of arranging the districts, erect-
ing the asylums, and providing for the proper care and treatment of the
insane poor. In the event of neglect by the visitors or district boards to
erect an asylum, the Commissioners are authorised to apply to the Secretary
of State, or the Court of Session, for authority to compel them. But
neither in England nor in Scotland have the Commis>ioners power to
require that medical appliances or particular articles of furniture shall be
supplied. Their functions are limited to visitation and reporting ; but it is
firee to the visitors in England, and to the district boards in Scotland, to
adopt or reject any of the recommendations which the reports of the
Commissioners may contain. The results of this system, however, have
been so favorable, that in no country in the world are the asylums for
the insane so well conducted as in Great Britain. We hold, then,
that the boards for the management of the proposed metropolitan
asylums should be nominated under direct statutory authority, and nowise
at second-hand by the Poor-law Board. The evils of the present system
have, we believe, arisen from throwing the powers of the guardians chiefly
into the hands of men of narrow education and restricted views, who are
incapable of acting in an enlightened and liberal spirit. To avoid this error,
the new boards should be elected by a higher class of ratepayers — by such,
perhaps, as are assessed on an annual value of at least £100; but it would
be a mistake to require a similar, or indeed any fixed, amount of annual
assessment as a qualification for the district board. A provision of this kind
might lead to the exclusion of the men best calculated for the satisfactory
discharge of the duties — of professional men, for instance, who were still on
the threshold of their career, with knowledge and leisure, but without fuuds
to live in a high-rented house. — Scotsman, March 7th.

The Supervision of Lunatics in Private Dwellings,

Year by year, the difficulties of making proper provision for the care of
the increasing numbers of the insane poor grow more and more formidable.
The last Report of the English Commissioners in Lunacy, telling as it does
of the frequent enlargements of existing asylums, of the building of new
asylums, and of the continuing pressure for increased accommodation,
repeats an oft-told tale, which has ceased to excite attention only because of
its familiarity. Of forty-five county and borough asylums in England,
more than half are nearly full, quite full, or more than full ; while those
that have yet some accommodation left are not likely to have it long, at the
present steady rate of yearly increase in the number of the pauper insane.
No wonder that a feeling has grown up in some minds, and is now finding
active expresssion in ditferent quarters, that some means should be adopted
of relieving the pressure on the overgrown and overcrowded asylums, other
than the multiplication of their numbers and the increase of their size.
With thif aim, the system of placing insane patients in private dwellingi^

136 Noie9 and News. [April,

under suitable regulations, has been advocated ; and we haye more than
once directed attention to the proposal, not only because of the promise
which it offers of getting rid of a fast-growing difficulty, but because it
assuredly requires careful consideration ere it be sanctioned and carried into
effect. The last Report of the Scotch Lunacy Board furnishes some valu-
able data for the formation of a judgment upon a question which has hitherto
been discussed on theoretical grounds, rather than from a practical point of
view.

In Scotland there are at the present time upwards of 1600 pauper insane
persons living in private dwelhnss at a moderate cost, against 2*299 pauper
insane maintained in public asylums at a more than d(mble cost. What,
then, is the condition of these single patients? We learn from the full
reports of the Deputy Commissioners, whose work it is to visit them, to in*
spect the accommodation given them, and regiilarly to supervise their treat-
ment, that their condition, bad as it unquestionably was some years ago, has
now been rendered eminently satisfactory. Indeed, Dr. Mitchell, one of the
Deputy Commissi(mers, can now venture to say confidently that for 1500
of these incurable and harmless insane living in private dwellings a reason-
able provision has been made, and that their happiness and comfort would
not be increased by any other mode of management. **They enjoy life
more," he adds, " and will live longer than they would do if placed either in
poorhouses or asylums; and to leave them where they are is the course
which is at once humane and economical." In face of this official declara-
tion, it will be necessary to pause before rejecting on theoretical grounds in
England a plan which seems to have been justified by such complete prao*
tical success in Scotland.

If any steps be taken in the same direction in this country — if the experi-
ment be tried of placing some of the harmless insane in private dwellings,
and thus opening an outlet of relief to the overcrowded asylums — it will be
of prime and essential importance to provide most stringently for the
frequent and systematic supervision of them. There sh<;iuld certainly be
appointed officers like the Deputy Commissioners of Scotland, or like the
Chancery Visitors of En;;land, whose duty it should be to visit regularly
these single patients, and to examine into their treatment ; and not only so,
but to search out the many insane persons who are undoubtedly now living
illegally in different parts of the country, unknown to the Commissioners,
without proper orders and medical certificates. The law enacts that every
Chancery patient must be seen by the proper authorities once each quarter,
and that every patient in a private asylum must be visited officially at least six
times a year — by the Commissioners in Lunacy, if the asylum be within the
metropolitan district ; by the Visiting Justices and the Commissioners, if it be a
provincial asylum. What is necessary for patients under the j urisdiction of the
Court of Chancery, or in private asylums, is still more necessary for single
patients living under the charge of any irresponsible person who may choose
to receive them for profit, and under circumstances in which the danger of
abuses growing up is very great. Indeed, the experience of the Scotch
Lunacy Board has shown conclusively that the character of the treatment
of insane persons in private houses is entirely dependent on the completeness
and adequacy of official inspection. The horrible and wretched state of the
Scotch single patients, before a system of regular inspection was instituted,
as compared with their present comfortable and contented condition — many
of them now being regularly, and some of them even profitably, employed —
was very similar to the heartrending condition of the insane in asylums
years past, as compared with what it is now, when more enlightened views
prevail and better management is ensured. In one of the Scotch counties,
m which many single insane patients are now living, satis&ctorilj cared for

1867.] Not49 and News. 137

in erery regard, a young woman had lived for many years naked in a

frightful cage, while her sister had been allowed to wander almost naked in

tbe woods ; another young woman had passed her life constantly chained to

a big stone ; a man was confined in a bare, windowless cell, which had been

bailt expressly for him ; others were found miserably neglected, naked,

£Jthy, and half-starved. It is probable that those who were responsible for

this cruel neglect did not err from any actual cruelty of disposition,

but from the vulgar, unreasoning horror of the insane, and from an entire

^orance of what their condition demanded. But one ffreat advantage of

official inspection was, that it was official instruction ; and so it has come to

pass in Scotland that, in proportion as those having the care of sinsle

patients have been penetrated with better views of their acquirements, tne

means of their treatment has undergone a remarkable improvement, and

now leaves little or nothing to be desired. It is a question, then, which

may justly claim to be carefully weighed, whether the extension to England

of a system which now works so well in Scotland can be advantageously

made ; or whether, on the other hand, there are special circumstances in the

latter country which render its success there exceptional.

Whether it be thought desirable or not to supplement the present inade-
(|aate asylum system m England by placing harmless and incurable lunatics
in private dwellings, there can be no manner of doubt of the necessity of a
more regular and stringent inspection of single patients than is at present
practised, or is indeed practicable with the existing staff of Commissioners.
On the 1st of January, 1865, there were 212 single patients who had been
certified according to the statute, and the number had increased to 227 on
the Ist of January, 1866. Of these, 43 were Chancery patients, so that
there remained only 184 patients whom it was necessary for the Com-
missioners to visit. To these, only 191 visits were made during the year;
whence it follows that, with few exceptions, each certified patient was
officially seen once in the year. Every one must admit this to be an
entirely inadequate inspection. But this is not all: it is quite certain
that numbers of insane persons are living as lodgers throughout the country
without being legally certified ; and though the Commissioners, when they
accidentally discover such a case, endeavour to vindicate the law by pro-
secuting the offenders, yet they are unabie, being already so fully occupied,
to take proper steps for searching out these illegally placed insane patients,
and for affording them the protection which they should rightly have. It
needs not the occasional revelations of ill-treatment which occur and excite
a painful sensation, to prove that many of the insane are still deprived
of that protection to which, by their helpless state, they are peculiarly
entitled. — British Medical Journal, January 1 2.

Medical Psychological Association,
The Annual MeetdJg op the Medico-Psychological Association for

1867 WILL BE HELD IN LONDON, UNDER THE PjlESIDENCY OJP De. LoCKHART

Robertson, early in July.

Communications, &c. &c., in reference to the Annual Meeting to be
addresied to the Honorary Secretary (Dr. Harrington Tuke), 37,
Albemarle Street, London, W.

Publications Received, 1867.

' Trousseau's Lectures on Clinical Medicine.' Delivered at the H6tel-Dieu,
Paris, by A. Trousseau, Professor of Clinical Medicine in the Faculty of Medi-
cine, Paris; Physician to the Hotel-Dieu; Member of the Imperial Academy

XIII. ^^

188 Notes and Netos, [April,

of Medicine; Commander of the Legion of Honour; Grand Officer of the
Order of the Lion and the Sun of Persia ; Ex-Representative of the People in
the National Assembly, &c. &c. &c. Translated and Edited, with Notes and
A])pendice8, by P. Victor Bazire, M.D. Lond. and Paris, Assistant-Physician
to the National Hospital for the Paralysed and Epileptic ; Medical Begistrar
of the Westminster Hospital.

To be completed in Twelve Parts, demy 8vo, at 4b. each. Part I : — 1. Vene-
section in Cerebral Hsemorrhage and Apoplexy ; 2. Apoplectiform Cerebral Con-
gestion, and its Relations to Epilepsy and Eclampsia ; 3. Epilepsy ; 4. Epilepti-
fjrm Neuralgia ; 5. Glosso-laryngeal Paralysis ; 6. Progressive Locomotor Atfuy i
7. AphasiR. Part II: — 8. Progressive Muscular Atrophy; 9. Facial Paralysis;
10. Cross-Paralysis ; 11. luikntile Convulsions ; 12. Eclampsia of Pregnant and of
Parturient Women ; 13. Tetauism ; 14. Chorea ; 15. Semle Trembling and Para-
lysis Agitans ; 16. Cerebral Fever and Chronic Hydrocephalus ; 17. Neuralgia.
Part III, in the press, will contain — Cerebral Rheumatism; Exophthalmic
Goitre; Angina Pectoris ; Asthma; Hooping-cough; Hydrophobia.

Wtll be reviewed in our next number,

*Traite des Maladies Mentales, Pathologic et Therap6atique/ par W.
Griesinger. Traduit de TAllemand (2e Edition), sous les yeux de I'Autear, par le
Dr. Domnic, M6deciii dela Maision Centrale dePoissy. — ^Paris: 1866. Pp. 592.,

* Medicine and Psychology : tlie Annual Address to the Hunterian Sooietj
for 1866.' By Dennis de Berdt Hovell, F.R.C.S. Eng.— London : Bell & Daldjr,
186, Fleet Street.

' St. George's Hospital Reports.' Edited by John W. Ogle, M.D., F.R,C.P.,
and T. Holmes, F.R.C.S. Vol. I. Contents :— 1. Some Account of St.
George's Hospital. By Dr. Page. — 2. Contributions to the Surgery of the
Heao. No. I. On the Deviations of the Base of the Skull in Chronic Hydro-
cephalus. By Mr. Prescott Hewett.— 3. Iodine Lajection in Meningocele.
By Mr. Holmes. — 4. On the Tjrphus Epidemic of 1864-5. By Dr. Reginald
Thompson. — 5. Notes on an Epidemic of Typhus at Leeds. By Mr. Clifford
Allbutt. — 6. On Progressive Locomotor Ataxy. By Mr. Lockhart Clarke.—
7. On Rheumatic Intis. By Mr. Rouse. — 8. On Cerebral Symptoms pro-
duced by Pressure on the Contents of the Labyrinth. By the late Mx. Toynoee.
— 9. On some Points connected with the Treatment of Hernia. By Mr. J. W.
Haward. — 10. On Amputation at the Hip-joint. By Mr. Holmes.— II. On
Disease of the Brain as a Result of Diabetes Mellitus. By Dr. John W.
Ogle. — 12. On Jaundice. By Dr. H. Bence Jones. — 13. On Puerperal
Paralysis. By Dr. Kussell, of Brighton. — 14. On Hypodermic Injections. By
Mr. Hunter. — 15. On Cong'cnital Dislocations of the Femur. By Mr. Brod-
hurst. — 16. On the Diurnal Variations in the Temperature of the Human
Body in Health. By Dr. William Ogle. — 17. On Rupture of Arteries from
External Injury. By Mr. Pollock. — 18. On Disease of the Cerebral Vesseb.
By Dr. Dickinson.— 19. On Talipes Varus. By Mr. Brodhurst. — 20. On
Talipes Equinus. By Mr. Nayler. — 21. On the Statistics of Amputation at
St. George 8 Hospital. By Mr. Holmes. — 22. On the Statistics of the Dental
Department of St. George's Hospital. By Mr. ^Vasey. — ^Annual Medical
Report for 1865. By Dr. Octavius Sturges. — ^Annual Surgical Report for
1865. By Mr. Pick. — ^London: John Churchill and Sons, New Burlii^gton
Street. 1866.

* On Epilepsy, Hysteria, and Ataxy.' By Julius Althaus, M.D., M.R.C.P.,
Physician to the London Infirmarjifor Epilepsy and Paralysis. — London : John
Churchill and Sons, New Burlington Street. Crown 8vo. Pp. 126.

We shall refer to this essay in our next number in connection with Mr. Lockhart
Clarke's able Monograph on Progressive Locomotor Ataxy in the St, Georges
Hospital Reports.

1867.] Notei and News. 189

'On Uncontrollable Drunkenness; considered as a Form of Mental
Disorder. With Suggestions for its Treatment, and the Organisation of
Sanatoria for Dipsomaniacs.' By Forbes Winslow, M.D. Aberd., D.C.L.
Oxon. London : JRobert Hardwicke, 192, Piccadilly. 1867. (Pamphlet.)

^Kevelation and Science: being a Critical Examination of a Sermon on
"The Unsearchableness of God," preached at St. iMattthew's Church, Not-
tingham, on Sunday, August 26th, 1866, on the occasion of the Meeting of the
British Association for the Advancement of Science.' By Daniel Moore, M.A.,
Honorary Chaplain in Ordinary to the Queen, &c. ; Author of * The A^e and
the Gospel,' &c. By T. Wilson, M.D., Member of the British Association.
Rivingtons, London, Oxford, and Cambridge. Nottingham: R. Allen and
Son. 1866. (Pamphlet.)

'On Lisanity and the Criminal Responsibility of the Lisane.' By Thomas
More Madden, M.R.I.A., Licentiate of the King and Queen's College of Phy-
sicians in Ireland. (Read before the Medical Society of the College of Phy-
sicians in Ireland.) — ^Dublin : John Falconer. 1866. (Pamphlet).

'Casuistry, Moral Philosophy, and Moral Theology. An Inaugural Lecture,
deliyered in the Senate House, Cambridge, on Tuesday, December 4th, 1866.'
By F. D. Maurice, M.A., Knightbridge Professor to the University of Cam-
bridge, and Incumbent of St. Peter's, Yere Street. London : Macmillan and
Co. 1866.

We congratulate the University of Cambridge on the accession of a man of genius
io the ranis of her teachers, and of having found so brilliant a philosopher to succeed
io the chair once held by Dr. WhewelL The University has, moreover, asserted in
tUt election her old predilections towards religious toleration. Forced to leave
king's College, London, under an imputation of teaching heresy, while professing
^ faith that^ deep as are the depths of hell, the power of Christ is greater, and
Sis love deeper. Professor Maurice may well console himself for the slight of past
yfars in the unanimous welcome with which the University of Cambridge greeted
ffii first appearance as Knightbridge Professor,

* Obituary Notice of Dr. ConoUy.* By Sir James Clark, Bart., M.D.
(Pamphlet.) Read at the Ethnological Society, June 12th, 1866.

'Modem Culture ; its True Aims and Requirements. A Series of Addresses
and Arguments on the Claims of Scientific Education, by Professors Tyndall,
Daubeny, Henfrey, Huxley, Paget, Whewell, Faraday, Draper, Masson,
De Morgan, Owen; Drs. Hodgson, Carpenter, Hooker, Acland, Forbes,
Groye, &c. Edited by Edward L. Youmans, M.D.— Macmillan and Co. 1867.
(See Part IT, Reviews.)

Appointments.

Mr. C. H. Moore, of Middlesex Hospital, has been elected Surgeon at St.
Luke's Hospital, in room of Mr. Luke, resigned. Mr. Luke has held this
office for thirty-four years. The duties include attendance at the Board with
the physicians for the admission of patients, and general surgical functions.
It is also the surgeon's duty to make a special report upon every case of injury
or of violent accident at death. — British Medical Journal, January 1 9.

Barker, J. C, L.R.C.S.L, has been appointed Junior Assistant Medical
Officer to the County Lunatic Asylum at Rainhill.

Campbell, John A., M.D., CM., Assistant Medical Officer to the Durham
County Lunatic Asylum, has been a{)pointed* Assistant Medical Officer to the
Cumberland and Westmoreland Counties Asylum.

Christie, Thomas B., M.D. St. And., M.R.C.P. Lond., F.R.C.P. Edin., late
of Pembroke House, Hackney, has been appointed Medical Superintendent of
the North Riding Asylum, Clifton, York.

140 Noie% and New», [Ap

Frederick Satton, M.R.C.S. Eng., L.S.A. Lond., Assistant Medical Oi
of the Norfolk Ck)unt7 Asylam, loiorpe, near Norwich, has been appoint
Medical Saperintendeut of the Norwich Borough Asylum, vice J. Hyde Mi
pherson, resigned.

Obituary.

Alexakdeb J. SuTHEBLAND, M.D., F.R.S. — ^After a linffering ilkess of f(
years, Dr. Alexander John Sutherland died at Brighton on the 31st January,
memoir of this eminent physician will appear in the next number of this Jonri

Notice to Correspondents,

English books for review, pamphlets, exchange journals, &c., to be sent eit
by book-post to Dr. Robertson, Hayward's Heath, Sussex ; or to the care
the publishers of the Journal, Messrs. Churchill and Sons, New Burling
Street. French, German, and American publications may be forwarded
Dr. Robertson, by foreign book-post, or to Messrs. Williams and Norgi
Henrietta Street, Covent Gkurden, to the care of their German, French, i
American agents, Mr. Hartmann, Leipzig; M. Borrari, 9, Rue de St. Fb
Paris ; Messrs. Westermann and Ck)., Broadway, New York.

Authors of Original Papers wishing Reprints for private circulation can h
them on application to the Printer of the Journal, Mr. Adlard, Bartholon
Close, E.G., at a fixed charge of 30«. per sheet per 100 copies, incladin
coloured wrapper and title-page.

The copies of Tke Journal of Mental Science are regularly sent by Book-
(orepfaiel) to the ordinary Members of the Association, and to our Home
roreign Correspondents ; and Dr. Robertson will be glad to be informed of
irregularity in their receipt or overcharge in the Postage.

The following EXCHANGE JOURNALS have been regularly received s
our last publication :

The Annates MSdico-Psychologiques ; the Zeitschrift fur Fsyehiatrie;
Correspondenz Blatt der deutschen Oesellschaft fur Pwehiatrie; Arehiv fur,
chiatrie ; the Irren Freund; Journal de MSdecine Mentale; Archivio Hal
per le Afalattie Nervose e per le Alienazioni Mentali; Medizinische Jahrbu
(Zeitschrift der K. K, Geseltsckaft der Aerzte in Wien) ; the Edinburgh M&k
Journal; the American Journal of Insanity ; the British and Foreign Met
Chirurgical Review; the Dublin Quarterly Journal; ;the Medical Min
the British Medical Journal; the Medical Circular; and the Journal of
Society of Arts. Also the Momingside Mirror ; the Fork Star ; Excelsior y or
Murray Royal Institution lAterary Gazette,

The Honorary Secretary has received the following letter: —

Vienna, 2.9, 1861
Sm, — I present you my respects and sincerest thanks for the honon
being created an ^norary Member of your celebrated Medico-Psycholo^
Association.

Feeling myself much flattered and honoured by that election, I shall alf
do my best endeavours to avail myself of it.

At the same time, I beg leave to present to the Association my Compendi
'Lehrbuch der psychischen Krankheiten.'

I am. Sir, with much respect.

Your obedient servant.

Max Leidesdorf, '
To Dr. Tuke, Hon. Sec. Professor at the University ^ Fiemk

MedicO' Psychological Association.

(Jo. 62. Hew Series, No. 26.)

THE JOXmNAL OF MENTAL SCIENCE, JTJLT, 1867.

[Published by authority of the Medico- Psychological Association,"]

CONTENTS.

PART I. -ORIGINAL ARTICLES.

PA OH

'• Kitching, H.D. — ^The Case of Henry Gabites ; a Medico-legal Study . 141

^' i. Gasqnet, H.B. Loud. — Oh Progressive Locomotor Ataxia . .157

***t>n J. Knndy, H.D. — Introductory Lecture to a Course on Psychiatry, ,

delivered at the Imperial Joseph Academy in Vienna . . 168

^ "W". D. Williams, M.D., L,R.C.P.— CTtnica/ Cases. The Non-restraint System

in the Treatment of a " certain class of Destructive Patients" . 176

PART II. -REVIEWS.

^tocy and its Treatment by the Physiological Method. By Edward Sbguik,

M.D. New York : William Wood and Co., 1866 . . 188

'-■^fitnres on Clinical Medicine, delivered at the Hotel-Dieu, Paris, by A.
Trousseau. Translated and edited, with Notes and Appendices, by
P. Victor Bazirs, M.D. Lond. and Paris. London : Robert Hard-
wicke, 1866 . . . . . .197

^i« Pathologie und Therapie der Psychischen Krankheiten fiir Aerzte und
Studirende von Dr. W. Gribsinger, Professor der Medicin und
Director der medicinischen Klinik an der Universitat Ziirich, Zweite,
umgearbeitete und sehr vermehrte Auflage. Stuttgart^ 1861.

^nit6 des Maladies Mentales, Pathologie et Therapeutique. Par W.
Griesinobr. Traduit de FAlIemand (2nd edition), sous les yeux de
PAttteur, par le Dr. Doumic, M^decin de la Maison Centrale de Poissy.
Pans, 1865.

'^tal Pathology and Therapeutics. By Professor Gribsinger, M.D.,
&c. &c. Translated from the German (2nd edition) by C. Lockhart
Robertson, M.D. Cantab., and James Rutherford, M.D. Edin.
Published by the New Sydenham Society. London, 1867. (Second
Notice) . . . . . .208

St. George's Hospital Reports. Edited by J. W. Oglb, M.D., F.R.C.P., and
T. Holmes, F.R.C.S. Vol. I, 1866. London: John Churchill
and Sons . 217

ii Contents,

PART 1 1 (.-QUARTERLY REPORT ON THE PROGRESS OF PSYCHOLOGICAL

MEDICINE.

1. Italian Psychological Literature. By J. T. Arlidob, M.B. and A.B.

Lond., M.R.C.P. Lond., &c. — Lunacy Reform. By Castiglionl —
Pseudochromestesia. By Dr. Brrti. — Anatomy and Physiology of
the Phrenic Nerve. By Professor Pinizza. — Melancholia, terminated
hy Erysipelas. — Pathology of Insanity. — A Singular Case of
Neurosis. By Dr. Carlo Berarducci. — On a New Mode of Deve-
lopment of Calcareous -Concretions within the Cranial Cavity. By
GiuLio BizzozERO. — On Madness and Genius. By Dr. Lombroso.
— Report on a Case of Wife-raurder. By Drs.jTAccHiNi, Bonfanti,
and ZuFFi. — On the Use of Bromide of Potassium and Bromide of
Quinine in Nervous Diseases. By Dr. Liberalt. — On the Old and
New Asylum of St. Nicholas of Sienna. By Carlo Livi. — On the
Classification of Mental Disorders, and on their Treatment by Coca
(Erythroxylon coca). By Professor Mantbgazza . . 219 —

2. German Psychological Literature, By John Sibbald, M.D. Edin. —

* Allgemeine Zeitschrift fiir Psychiatric/ vol. xxiii, 1866. — On Delusions
of the Senses. ByDr.KAHLBAUM. — Mania acutissima occurring during
a Paroxysm of Intermittent Fever. By Professor ErhArdt. — The
Clinical differential Diagnosis between Dementia Paralytica and other
Cerebral Diseases which produce Insanity and Paralysis. By Dr.
V. Erafft-Ebing. — Further Researches concerning Hereditary In-
fluence in Insanity. By Dr. Jung. — Mental Freedom : a Principle
in Forensic Psychology. By Dr. Wiebecke. — Adhesion of the Pia
Mater to the Cortical Substance of the Brain. By D. L. Besser. —
Pneumonia and Mental Derangement. By Dr. Wille. — The History
and Literature of Dementia Paralytica . . 235—

PART IV.-NOTESA^D NE^S.

Presentation of Dr. ConoUy's Bust to the Royal College of Physicians. —
Dr. Maudsley on the Physiology and Pathology of the Mind. — Was
Luther Mad ? — Recent Contributions to Mental Philosophy. — A Chan-
cery Lunatic. — Emanuel Swedenborg. — Dr. Forbes Winslow on Light.
— Modern (Romish) Ideas of Hell. — Pavilion Asylums. — The Empress
Charlotte. — Publications Received, 1867. — Appointments. — Extra-
ordinary Meetings of the Medico-Psychological Society of Paris . 254—'

Notice to Correspondents . ' . . . . . I

Annual Meeting of the Medico-Psychological Association for 1867 .

List of Members of the Medico-Psychological Association

^0. 63 {new series No. 27) will he published on the

1st of October, 1867.

THE JOURNAL OF MENTAL SCIENCE.

[I^Mished by Authority of the Medico-Psychohgieal Association,^

N^o. 62. ^No™^' JULY, 1867. Vol. XHI.

PART I.— ORIGINAL ARTICLES.

"^^ Case of Henry Oabites; a Medico-legal Study. By John
KiTCHiNG, M.D., Medical Superintendent of the Friends^ Ee-
treat, York.

At tie winter gaol delivery for the West Riding of York, held
t Leeds in December, 1866, Henry Gabites was indicted for the
"^^arder of Arthur Allen.

Henry Gabites and Arthur Allen were fellow-apprentices to a
^feiper in Fargate, ShefiBeld, whose name was Edward Draper. Ga-
\)ites was sixteen and a half years old ; Allen was a year and a half
Jounger, and had only been in the business about nine months. The
two youths slept together in the same room, and had the room to
themselves. Since the arrival of Allen, as the youngest apprentice,
he and Gabites had been companions and friends. They had had
no quarrel, so far as the rest of the family had observed, up to the
time of the tragedy, although a slight event had occurred a few days
previously, which had, to some extent, altered their mutual feelings.
In the week preceding the death of Allen, he and Gabites had
taken a walk together, in the course of which they entered a con-
fectioner's shop, and Allen bought some refreshment, for which he
could not pay. This irregularity was reported to Mr. Draper, and
the latter, in the exercise of a laudable care for the moral conduct of
his family, forbade the youths to leave his house after business hours
till further notice. The prohibition was made on Saturday. On
Monday night Gabites was observed to be dull and heavy, and com-
plained of headache. His companion and himself went to bed, and
appeared to be on their usual friendly terms. The following morn-
ing Ctabites went, about half-past seven o'clock, to his master's
VOL. xni. 11

142 The Case of Henry Gabiles ; [July,

bedroom, and, knocking at the door, said, '^ I have killed Arthur/*
His master asked him what he meant. He said again, ^^I have
killed Arthur/' In reply to a further question, he added, " I have
murdered him with a hammer, and stabbed him with a knife/* On
being asked what he had done it for, he replied, ^'For revenge/*
Mr. Draper rushed to the bedroom, and found the narrative too
literally substantiated by what he saw. Allen was lying in bed on
his back, in a pool of blood. There was a carving-knife on the bed
beside him, and a hammer on the dressing-table. Mr. Favell, the
surgeon, was sent for, and he found three wounds on the person of
Allen — one about two inches in extent on the left temple, another
upon the crown of the head, and a third under the left ear. The
first was a fracture and depression of the skull, the temporal bone
was broken, and a portion driven in upon the brain. The second
was a fracture upon the crown of the head, but the bone was not
driven in or displaced. The third wound, in the neck, was super-
ficial. The wounds on the head were evidently produced by a blunt
instrument. Death rapidly ensued.

Gabites was sent to the town hall, in charge of a fellow-appren-
tice, whom he asked on the way what he should say when they
arrived. He was told to say that he had killed Arthur Allen; and
he gave the policeman an account of the deed nearly in the words
he had first used to his master.

So rude and violent an interruption to the peaceful current of
domestic life in a well-conducted family naturally drew an unusual
amount of curiosity to the antecedents of a youth who had startled
it with so dire a tragedy. Domestic broils, youthful quarrels, heart-
burnings, and jealousies, amid the miscellaneous persons employed
in a trading establishment, are sufficiently common, and are usually
settled by squabbles and petty acts of retaliation, which are ordi-
narily unknown beyond the narrow circle in which they originate;
but the sacrifice of life as an atonement for some petty ofPence, or in
revenge for some slight injury, is an event so strange, and presents
so much that differs from the ordinary incidents of murder, that it
is no wonder if public curiosity was much excited regarding the
history and mental condition of the stripling homicide. Did this
disaster, by which the life of an unoffending boy was destroyed,
spring from the bloodthirsty passions of a miscreant, or the insensate
surrender of a weak and unsound mind to the temporary domination
of a homicidal impulse ? Was Gabites, in the ordinary sense of the
term, a fully accountable being, or was he affected with some form
of insanity which deprived him of the powers necessary to resist
temptation and curb his impulses ? Was he, in fact, a murderer or
a maniac ? These were the questions naturally asked by every one.
They were thoroughly investigated at the trial, and an endeavour
was then made to solve them. The present paper contains an

1867.] a Medico-legal Study , by Da. J. Kitching. 143

account of the principal features of this trial, and what the writer
regards as a solution of the questions above propounded.

Henry Gabites was bom on the 16th of March, 1850. He was
the youngest but one of seven children. His mother was a delicate
woman, and died about ten years ago of consumption. She was a
fond and affectionate mother, and devoted herself to the welfare and
training of her children. The father was a painter by trade, and so
long as his first wife lived was in comfortable circumstances. When
about a year old, Henry was attacked with fits. Under medical
advice leeches were applied, and the mother, thinking what was
once beneficial would always be so, kept leeches in the house, to be
ready whenever the fits returned, which they continued to do for
about two years. As the fits declined, they gave place to deafness,
which remained with varying intensity for many years. The mother
was apprehensive that the duration and severity of the fits had seri-
ously affected the child's constitution, and she was several times
heard to say she hoped it would please the Lord to take Henry
before hersefr, for she was afraid the fits would make him wanting in
mind. She lived long enough to see her fears realised. She ob-
served an evident defect in the mind of her boy. He had not the
sprightliness and vivacity, nor the intellectual capacity common to
children of his age. Those who knew the family noticed that Henry
vas a dull, feeble-minded boy. They described him as stupid and
^, having a vacant, soft, and simple look. He was also shy and
Ktiring, not entering into the pastimes of other boys. Along with
these intellectual defects, it was allowed on all hands that he was an
J^Daiable, docile boy, having never exhibited any approach to malice
or vindictiveness. The teacher of the day-school which he attended
regularly up to the time of his mother's death, irregularly after it,
<luring a period of seven years, deposed that he always had a smile
or smirk on his face. There seemed a vacancy and innocency in him
tlifferent from the other boys. His disposition was very amiable,
Bot at all vindictive or rough, remarkably easy to guide. He was
Jiiffident and retiring, seldom in any scrape, always on good terms
with his playmates.

Up to the age of six years he had the advantage of a devoted
mother's tender and bving care. After a year's interval a woful
domestic change took place. His father married a second wife — a
young woman whose character and conduct presented a most un-
happy contrast to those of her predecessor in his affections. The
fortunes and respectability of the family rapidly declined. To Henry
and his younger sister the change was portentous. The second
Mrs. Gabites possessed neither affection nor feeling for the children.
She was a woman of a violent temper, and treated the children with
more than the proverbial harshness of a stepmother. Her conduct
towards them is represented as persecuting and cruel. She kept

14'J' Tlie Case of Henry Gabites ; [July,

them almost constantly engaged in hard and slavish toil, and forced
Henry to do the work of a domestic drudge — scouring the floors,
washmg the walls, &c. She kept him short of food, so that the
neighbours often gave him bread in secret. She beat him till he
was bruised and sore, and rendered his life abjectly miserable. To
this physical ill usage was added the bitterness of threats and de-
nimciations that he would some day come to the gallows. His
weak and tender mind was so cowed and overawed by this tyranny,
that he acquired a full belief in the future realisation of this predic-
tion. During the time he was thus ill-treated he is described as
being amiable and docile — more like a girl in character than a boy —
timid, shrinking, and compliant. From an early age he had been
sent to school both on week-days and Sundays. Whilst his mothei
lived his attendance was regular ; after her death it was much less
so. A few months previously to his going to Mr. Draper's he was
employed as an errand-boy by a draper in Hull, from which place he
went to ShefBeld.

The above details form a brief outline of this wretched boj's
career up to the sad crisis in which it has culminated. Very early
in life an aggravation of the sufferings to which infancy is exposed,
followed by infirmity of body and mind, suflScient to rouse the soli-
citude of a kind and watchful mother for the future reason of her
boy ; then the transference to the hard discipline of a cruel step-
mother, who pursued a course of treatment strangely adapted to
aggravate any feebleness or imperfection in the mental or moral
constitution of the boy, or even to impair it if sound; finally, the
awful catastrophe, so unlike the succession of developments in ordinary
lives : — these form materials for interesting psychological study, and
challenge careful inquiry whether there be here the usual ingredients
of criminal ebullition, or the natural procession and result of psy-
chical disorder. The. friends of Gabites thought there was sufficient
reason in his history and the inexplicable nature of his crime to doubt
his sanity ; and, with a view to his defence on that ground, they en-
ffaged Dr. WillLims and the writer to examine him. This, of course,
IS the usual practice in criminal trials. The law presumes every man
to be sane till he is proved to be the contrary, and it lies in the defence
to bring forward the proof. Looking at this practice with r^ard
to the elimination of truth, it has patent disadvantages. Its ten-
dency is in favour of partisanship, and against that caLoa impartiality
with which a weighty scientific question involving the distinction of
disease from crime, and the issues of life and deaths ought to be
investigated. Perhaps it is impossible for any one, however great
may be his desire for an impartial and just conclusion, not to be in
some degree biased towards that view of the question which he
knows he is sent in the hope of being able to support. It is very
probable that this consideration may have the effect of somewhii

1867.] a Medicolegal Study, hy Dr. J. Kitching. 145

magnifying the minor indications^ and of inclining the scale of opi-
nion in what might otherwise be held doubtful. But there is this
to be said : what holds true of one side is equally true of the other ;
80 that the net result may simply be a more or less exaggerated in-
terpretation of the symptoms making in favour of each side. If this
be the case with regard to medical evidence, it is in a higher degree
true of non-professional evidence. The measurement of human in-
tellect is not based upon any standard which is universally accepted.
Every person estimates mental competence according to a standard
of his own fixing, or by reference to some other individuals who,
according to the different points of view from which they are re-
garded, may hold very different positions in reference to mental
capacity or deficiency. This liability to a variation in the standard
is farther increased when the intellect is immature from youth.
Another element of complexity is introduced into the problem — an
additional source of vagueness and uncertainty. Hence it happens
that what appears gross stupidity to some is only a common medio-
crity in the eyes of others. What seems proof of a weak capacity
according to the judgment of one witness, is compatible with ordi-
iiary ability in the view of another. The conscious shrinking which
indicates, in the opinion of some, an over-sensitive and morbid
moodiness of mind, possesses, in the estimate of others, the character
of a proper and natural shyness. A shy disposition explains the
phenomenon to their satisfaction. The word *^ disposition"— the
relative position and mutual influence of the various tendencies in
the mind as they commingle and manifest themselves in resulting
cliaracter — is an admirable term, but when used as explaining morbid
phenomena, it obscures instead of throwing light upon them. These
remarks refer to a class of difficulties in the way of arriving at a
nniform conclusion, which reside in the minds of those from whom
testimony is sought. There are other and formidable difficulties
inherent in the subject itself. The moral and intellectual training,
including the associations and influences to which an individual has
been exposed, forms a prominent element of the difficulty alluded to.
A mmd originally weak may be strengthened by culture; defective
moral faculties may be invigorated by careful training. Ticious
propensities may be repressed ; violent impulses may be assuaged ;
morbid irregularities may be tempered. If the domestic and social
circumstances of a young person have been favorable, these results
will undoubtedly, in a greater or less degree, have been brought
about. On the other hand, if the circumstances have been adverse
to the implanting and promotion of what is good and virtuous, the
opposite result will follow, and what is morbid in the character will
be strengthened and developed. If the process of wise training be
suddenly cut short, and succeeded by a mode of treatment which is
calculated to vitiate what is good, and exasperate what is bad and

146 The Case of Henry Gabitei; [Julj^

defective, the eflfect may be naturally expected in a confused jumble
of opposite and contradictory manifestations, the unhealthy and dis-
proportionate ascendancy of evil propensities strangely and hideously
contrasting with other and better qualities^ perhaps, more habitually
displayed.

These considerations, however imperfectly set forth, are strictly
relevant to the case in point. The determination of the soundness
or unsoundness of mind in a person so young as Gabites, standing
in the terrible position he did, required that all these sources of diffi-
culty— in other words, sources of error — should be held in view,
and demanded all the elucidation which the circumstances of his past
life could throw upon them. There is also another consideration ol
some importance not to be lost sight of in the difference between the
insanity of juvenile and of adult persons. Juvenile insanity more
easily escapes detection, or eludes observation under a latent form,
than when it exists in adult or more advanced life. Cases are quite
common in which insanity has been creeping along with the ad-
vancing years of a boy or girl, every now and then strongly sus-
pected, but not fully recognised until it has burst out in some sudden
act of unmistakable madness. In tender years there are not the
same data for comparison as at a later period of life. An adult has
an established character — a long series of antecedents to appeal to —
a long array of duties discharged or responsibilities sustained, as a
basis for instituting a comparison or forming a judgment. But with
all these faciUties for discrimination in the case of adults, the access
of mental impairment in them is often so gradual, and comes under
so many varieties of guise, that the early indications are recognised
with difficulty, and only clearly accepted for what they are when
they have undergone further development, and entered upon the
domain of confirmed lunacy. If this be so with adults, it is much
more so with young persons. In early youth, the freaks and eccen-
tricities of temper, to which that age is liable, cast a blind over the
incipient manifestations of mental disorder, and quiet alarm as to
their real tendency. They are the vagaries of a nature not subjected
to the control of a developed and intelligent will — the weedy crop ol
a life not yet subjugated by a sense of responsibility, which will grow
with an increase of days, reduce the moral chaos to order, and put
the bridle of a respectable regularity upon it. These expectations
are doomed to disappointment by the explosion of the morbid ener-
gies in some flagrant act of cruelty or violence. Then a flood ol
light is thrown upon the indications of the past, and the insanity so
disastrously declared absorbs the accumulated irregularities that
have gone before, and binds them into a thick bundle of tangible
disease.

The practical application of these remarks to the diagnosis oi
juvenile insanity is obvious ; but the physician is placed at a great

1867.] a Medico-legal Study , hy Dr. J. KrrcHiNG. 147

disadvantage when the symptom which most of all satisfies his own
judgment consists of some flagrant violation of the law or some
desperate injury to life or limb. He is suspected of a desire to screen
a criminal, or serve some humanitarian crotchet of his own. The
cloudy region of motive has necessarily to be travelled through, and
the adequacy or inadequacy of the reason assigned, or the object to
be attained on the supposition of a mind in full possession of its
powers to be discriminated. No case in recent times affords a better
illustration of what is here adduced than that of the unfortunate
Townley.

There does not appear to have been much in his previous history
to give very clear data for the conclusion that his mind was unsound,
and that the explosion which afterwards occurred was the natural
working out of the ascending force of the disease. The killing of
his sweetheart and his subsequent conduct were the most important
Hnks in the otherwise slender chain of evidence upon which the
diagnosis of his insanity hung. And how suspiciously and jealously
was this evidence received ! Yet now, after the whole tragedy has
been enacted, and what would have been has been suddenly enve-
loped in the black pall of death, who doubts Townley's madness ?
Cases like Townley's are surely very instructive, and should have
the effect of teaching the uninitiated something of modesty and diffi-
dence in dogmatising upon these difficult questions. A larger
amount of forbearance and respect might very well be awarded to
those witnesses who have been brought in their daily life into
doser contact with the sufferings and trials of their fellow-creatures,
and into closer intimacy with the secret miseries of families and in-
Qividuals than any other class of person's, than has sometimes been
awarded to them by the unconcerned public. These claims are
often too lightly esteemed, and too easily set aside by a thirst for
revenge and the false pretence of the security of society and protec-
tion against immunity for crime.

No one could undertake the duty of examining Gabites, and pro-
nouncing a conscientious judgment on his mental condition, without
iaving reflections similar to these suggested to him ; without being
impressed with the anticipation of what he might have to undergo
in court, or to sustain at the hands of a portion of the public which
prefers the excitement of an execution for murder to the dull and
disappointing process of being convinced that the accused is a
lunatic. It was always easier to divide the Gordian knot with a
sword than to perform the tedious operation of unravelling its
intricacies, and it continues to be so ; and to the sensational spec-
tator the slashing solution gives a livelier emotion, and is propor-
tionally relished.

The interests of humanity, however, and the vindication of the
truth, must not yield to any considerations of personal comfort, any

14S The Case of Henry Gabites ; [Jiily>

unworthy truckliDg to popular prejudice on the one hand, or the
fear of persecution and ridicule on the other. A cross-examination
when popular prejudice runs in favour of forensic licence^ is au
ordeal no one can enjoy ; but if it promote, by ever so little, the
estabUshment of sound principles, and throw abroad a spark of light
on a material theme, it must be unflinchingly encountered. It is a
privilege at the cost of any personal sacnfice to be made instru-
mental in the acceptance and diffusion of a valuable truth.

My visit to Gabites was on Sunday, the 16th of December. By
the kindness of the jailer I was permitted the use of his room^ and
the prisoner was brought in and allowed to remain with me as long
as I wished. As Gabites entered I was struck with his childish
appearance. He is a short, plump, pale-faced boy, standing more
than five feet one inch in height, of a timid and amiable expression
of countenance. The impression first conveyed is that of a ratha
engaging lad — ^it is only on a closer observation of his features that
you perceive a slightly dogged and suspicious look, due mainly to
the well-closed mouth and a certain restlessness in the eyes. His
look is, however, weak, simple, and unintelligent. The face is un-
symmetrical, the right side projecting considerably more beyond the
mesial line than the left. The teeth on the right side of the jaw
are large and coarse, jammed together, and irregular. The head is
rather large and broad, and, like the face, uusymmetrical on the
two sides, the right being larger than the left ; both sides, however,
displaying that character which has been called by anatomists ven-
tricular. The eyes are large, dark in colour, soft in expression, and
surmounted by good clear eyebrows. The conjunctivae are injected ;
but the pupils not contracted; rather open. Complexion pale,
sUghtly brown; skin a httle unctuous. On examining him with
regard to his mental capacity, it was evident that he was either badly
educated, or his abilities for acquiring knowledge were of a low^
order. His acquaintance with elementary learning was loose and
inaccurate. He gave me very decidedly the impression that his
intellectual abilities were below the average of boys of his own age^
A want of clearness of apprehension was evinced throughout. He
remembered a variety of particulars in the ordinary branches of
school education, but they remained vague and isolated in his
memory, and had undergone no intellectual assimilation. The same
holds good as regards his comprehension of things moral and reli-
gious. It is difficult to convey an idea of the superficialness with
which his answers impressed me as the all-pervading character of
his mind. A universal feebleness of tone both in the ideas and the
emotions suggested a poor cerebral organisation and defective func-
tion. There seemed no power of receiving deep impressions, and a
great want of the power of reflection. The affections had received
no cultivation for many years, and therefore could not be expected

1867.] a Medico-legal Study, hy Dr. J. Kitching. 149

to be very strong ; but his demeanour during my visit led me to the
conclusion that they were exceptionally inert or wanting. The
moral sense, the perception of the difference between right and
wrong, was not absent, but, like all the other faculties, was vague.
He had learned at the Sunday school the commandment, ^^Thou
ghalt not steal/^ and therefore knew it was wrong to steal ; but he
stole sometimes and iTelt no compunction for it. He knew the dif-
ference between truth and falsehood, but had told lies when it
suited him, without feeling condemnation. He had practised mas-
turbation, but stated that he had abandoned it, because he thought
it was "rude.^'

He answered the questions put to him frankly, and to the best of

iis power, without much reserve, and apparently without any attempt

to prevaricate or feign. His manner induced the belief that he was

simply telling the truth. Of course the most interesting portion of

the examination was that connected with the commission of the

murder. He spoke of the persecution and cruelty to which he had

been subjected, and the misery which he always felt from what he

bad to endure. He stated that he had been so often told that he

should come to the gallows, that he always believed he should.

The means by which he should come to this end would be by killing

somebody. Who this somebody was he had no idea. He often

thought he must kill himself, and once he had run away from home

with the intention of drowning himself; but his courage had failed.

This ruiming away was spoken to by some of the witnesses. When he

came to Mr. Draper's as an apprentice, he had a fixed belief on his

Blind that he must kill either himself or somebody else. For some

time he had slept in a room with a young man who was much older

i^nd bigger than himself. He had often thought of killing him,

Wt had never attempted to do it, because he was so much younger

Mid weaker than his companion. He had been very fond of Allen

(the victim) and had no spite against him, but when he was punished

by his master for what he considered Allen's fault, the idea of

Hlling Allen arose in his mind. It was on a Saturday that this

idea took possession of him; and on Sunday he went to Carver

Street Chapel, and whilst there his mind was entirely engaged with

the idea of the killing, and he made up his mind to do it. On

Konday he secreted the hammer and knife, denying all knowledge

of them when they were inquired for. He remained on friendly

terms with Allen all the time ; nobody observed any difference in his

behaviour tiU Monday night, when he felt very dull, and was asked

what was the matter, when he replied that he had a bad headache,

which was true. He went to bed and slept, but woke early in the

morning with the deadly purpose still fixed in his mind. He waited

till he could see, and then, whilst Allen was sleeping, struck him a

violent blow with the hammer on the temple. At this Allen started

150 Tlie Case of Henry Gahites ; [July,

up in bed and frightened him, when he again struck him, and the
poor fellow fell back insensible. But lest he should rise again or
make a noise, he (Gabites) then took the knife and stabbed him in
the neck. These horrible details were related with a stolidity and
an insensibility to their true nature, which, though inadequate to
the legal definition of " not knowing the nature and quality of the
act/^ could only arise from a most imperfect-appreciaton of its nature
and quality.

Having now accomplished his purpose, and believing that he had
now only done what he must some time or other have done, he left
the house and proceeded to the town hall in order to deliver himself
up to the police. By the time he reached the police-ofiBce he came
to the conclusion that the police would not beheve his tale, and that
it would be better to have somebody with him to corroborate it.
He therefore walked past the town hall ; and after rambling about '
the town awhile, returned home and informed his master as already
detailed. After the inquest he was kept in the police-cells, and slept
there alone several nights. He was not afraid of being alone in the
dark, and he slept as well as usual. He had no visions or startling
dreams, and had had none since coming to Armley Gaol. He was
now very sorry for what he had done, because he was afraid he
should be hung, and hanging was a thing he should dread. He had
rather be imprisoned for life. Dr. Williams examined him on the
following day ; but we did not meet till the day of the trial, and
then only in court. Our conclusions were therefore formed sepa-
rately and independently, and they were that Gabites was of unsound
mind. We both thought there was suflBcient evidence of this to
justify us in endeavouring to establish it in court. The prosecution
forthwitli engaged medical evidence to rebut our opinion.

It was evident, therefore, that this trial was to be another of
those medical and forensic contests in which victory was to be as
eagerly sought as truth, and in which an endeavour would again
be made to throw confusion over the diifference between sanity and
insanity, often suflBciently nebulous, by the refinements and absurdi-
ties of metaphysical definitions.

Dr. T. P. Smith, of the Mount Stead private asylum, examined
Gabites for twenty minutes on the morning of his trial, and dis-
covered nothing that was indicative of unsoundness of mind. Dr.
Smith stated that Gabites had conversed with him calmly and
rationally, had answered quietly all questions put to him, but had
volunteered nothing ; his answers were rational and pertinent to the
questions ; Dr. Smith had no doubt the accused quite understood
right from wrong. Dr. Smith stated that the " physique '^ of
Gabites was slightly defective, and the body small for his age;
that his head was undeveloped to a slight degree, and the lower part
of his face very receding and undeveloped. The rest of Dr. Smithes.

1867.] a MedicO'legal Study, hy Da. J. Kitching. 151

endence turned chiefly on the metaphysical character of homicidal
insanity and monomania^ and as having little practical appUcation to
the case in court may be passed over. His general conclusion was,
that because in the course of twenty minutes' conversation with
Gabites he had not detected unsoundness of mind, there was none,
and that the accused was a sane, and fully responsible person.

Dr. Smith was not asked, either in chief or cross-examination, a
angle question as to the motive which had induced Gabites to kill
Allen. Gabites had said, when asked why he had killed his fellow-
apprentice, that he had done it for revenge. Whether it was that
th^ allegation was considered by all parties so satisfactory and
natural that it could only be quietly accepted, or whether it was so
manifestly absurd and inadequate, that it was better for the prose-
cution to keep it entirely out of view, it is not easy to decide. Mr.
Waddy, for flie defence, seemed about to bring out this important
aspect in the case, when he asked Dr. Smith whether '^ if a man
committed a crime, which was entirely opposed to the whole current
of his previous life, and committed it, too, without any apparent
reason, that was not a sign of intellectual weakness ?" Dr. Smith
tepHed, "It might be a sign of mental weakness, but I should
expect some other signs.'* " No doubt,'' said the counsel, " but
would you expect other signs in the case of a youth who, when
a child, had been long subject to fits — would he not be more likely
to have disease of the brain than any other person who when a child
had not been subject to fits ? Dr. Smith, " Yes, he would be
more likely, certainly." Mr. Waddy, " Even at maturity would he
be more likely to have disease of the brain than a person who when
* child had not been subject to fits ?" Dr. Smith, '^ Yes, he would
DC more likely than a person who was perfectly sound, or in other
^ords, had never had fits." At this point the cross-examination
diverged into much less pertinent channels, and the impression it
Was likely to convey was attacked by the prosecuting counsel with
one of those questions so much more likely to hide than elicit the
truth in a special case. '^ Would you conclude that every man who
for the first time committed a crime was insane, having previously
led a good life ?"

A question put in this form is delusive, and if not intended, is
Calculated, by excluding a regard to special cases, to throw a blind
over them, as well as to cast ridicule upon the supposition that in
any case the commission of a great crime, by a man hitherto moral
and inoffensive, might result from disease. What is true of indi-
vidual cases is not true universally, and what is true universally flies
far above that which is equally and additionally true of special cases.
It is not true that in every case where a previously moral and inof-
fensive person commits a flagrant crime, his commission of that act
is a proof of insanity. His previous good conduct may aggravate

152 TAe Case of Henry Oabites; [July*

the criminality of the deed ; but it is true that in some cases the
first commission of a cruel, violent, or unlawful deed may be the
declarative symptom of an impaired mind.

Dr. Williams gave his evidence in a very direct and clear manner.
He thought the way in which Gabites committed the act for which
he was on his trial proved the unsoundness of his mind. Prisoner
had stated to him what I was ignorant of, that whilst he was killing
Allen, he was repeating the Lord's Prayer in a hurried manner — and
Dr. Williams came to the conclusion that Gabites was a homicidal
maniac.

The writer's evidence, as given at the trial, is fairly summed up in
the ^ Sheffield and Rotheram Independent/ from which the following
extract is taken as embodying its essentials : —

^^ Dr. Kitching said : ' I have examined the prisoner, and as the
result of my examination, I say he is of unsound mind.'

" Mr. Waddy (to witness). ' Will you explain the state of mind m
which the prisoner actually was ?' "Witness : ^ Yes. He is a very
imperfectly developed being, both physically and mentally. His
intellectual powers are feeble and have not been developed to the
average extent of persons at his age. His knowledge is very small
compared with his opportunities. His moral faculties are exceedingly
feeble and obtuse, and his knowledge of things with which boys are
usually well acquainted is exceedingly limited and imperfect. He
told me he had never heard the Bible read except when he was at the
Sunday school ; that at the Sunday school he was taught the ten com-
mandments very carefully and diligently, but that he could not tell
them in order at all ; that he had been taught all the books of the
Bible, but could not enumerate the first five, and the commonest facts
of our religion are unknown to him. As described by a previous
witness, he was " daft." There was such a want of common sense
in the lad, that I look upon him as a person of very imperfect mind,
both intellectually and morally. His intellectual and moral faculties
are so low that he is not to the ordinary extent an accountable being ;
and moreover he had an abiding delusion, grounded on this weak
and imperfect mind, that he must kill somebody, and when the first
opportunity presented itself on some little aggravation or other, his
mind became excited, he was driven beyond his self-control, and he
committed the awful act. That is the explanation 1 have to give of
the commission of this crime.'"

It will be seen from the foregoing quotation that there was no
attempt on the part of the writer to make out a case which should
bring Gabites under legal exemption on any criterion at present
recognised by the bench. Before the defence'was entered upon the
judge had quoted the following passage from the report of the judges
to the House of Lords : " That to establish a defence on the ground
of insanity it must be clearly proved that at the time of the com-

1867.] a Medico-legal Study ^ hy De. J. Kitching. 153

mittal of the act charged the accused was labouring under such a
defect of reasoning from disease of mind as not to know the nature
and quality of the act he was doings and that if he did know it^ he
did not know that he was doing what was wrong/' " That of course
referred to general insanity/'

According to this definition, legal exemption on the ground of
insanity is only accessible to persons who are either thoroughly mad
or thoroughly imbecile. It was not anticipated by those who gave
medical evidence for the defence that an acquittal could be secured
oa this basis, nor would it have been in the interests of science or
truth that it should be so. What was hoped was, that the jury
would have recommended the prisoner to mercy on the ground of his
weakness or unsoundness of mind. Instead of such a verdict he
was declared guilty, '^ with a strong recommendation to mercy from
the whole of the jury, on the ground of his extreme youth.''

Let us briefly recapitulate the reasons why in our opinion the
words "unsoundness of mind" might have been properly substituted
for " extreme youth."

In infancy Gabites was subject to epilepsy for two years. He was
repeatedly bled for the complaint, and when the fits ceased deafness
remained, and a peculiarity was noticed by his mother which led her
to fear that his mind was impaired to such an extent that she hoped
he would die. Whilst she lived he enjoyed the kind of home train-
ing which would best promote his physical and mental health, and
overcome the consequences of his early infirmities. With her death,
and the installation of the step-mother as the directing head of the
family, the moral atmosphere in which the boy lived was entirely
changed. The succeeding eight years of his young life were spent
in an atmosphere by no means calculated to strengthen a weak intel-
lect or invigorate defective moral powers, to implant firmness against
temptation, lessen the force of unsound impulses, or inspire correct
views of practical duty. The home influence appears to have become
nemarkably adapted to foster all that was weak and imperfect in his
mental and moral constitution, and to bring into prominence the
defects of his character, if not to implant veritable delusions.

The actual amount of injury done to the boy's mind by the hard-
ships to which he had been exposed cannot be accurately estimated.
It was probably much greater than could be satisfactorily shown by
evidence. The susceptibilities of a weak and timid child continually
wrought upon by the terrible ascendancy of a harsh and tyrannical
woman, would work fearful effects of terror and confusion. Nothing
is more likely than that the reiterated suggestion of a certain doom
as impending over the child, by such an overmastering influence,
might beget a belief in its truth, and implant itself on his mind with
the force of a delusion.
In a mind of this cahbre the distinction between an insane de-

154 The Case of Henry Gabites ; [JiJy>

lusion and the acceptance of a declaration as an article of belief from
mere weakness of mind is a difficult matter. The manner in which
Gabites consistently maintained that he always believed that he should
at some time kill either himself or somebody else, inclines me to the
conclusion that this belief was of the nature of a delusion. Under
the influence of a resentment which excited his weak brain and
produced headache, the delusion would recur with additional force,
because of the diminished power of resistance, and lead to its own
fulfilment. There must have been a psychological reason for the act
of bloodshed which took place. If this was not the reason, wha?
was? The existence of an ungovernable temper had never been
betrayed — ^there had never been outbursts of rage or ferocity; vicious-
ness and brutality seemed foreign to the nature of the lad. It
seems hardly possible to lay his homicidal act to the score of these
qualities. Then, again, the supposition of his being of sound mind
brings a strange contradiction to light in the inadequacy of the
motive.

The motive assigned was revenge. Lord Byron says : ^'Eevenge
is sweet " — but it is sweetest when taken in the full heat of the
burning passion which excites it. There are people who, like Shy-
lock, can nurture up a hope and intention of revenge with a malig-
nant coolness ; but these loathsome natures are the exceptions of
humanity, and there is no trace of such a thing in Gabites. The
assignment of revenge as his motive strikingly shows his weakness
of mind. He thought he must assign a motive and revenge seemed
to him the most plausible and natural one ; but the attributes of
revenge were all wanting. He declared he had no spite against
Allen — he was very friendly with him, and whilst he was killing him
he was saying the Lord's Prayer. Such an explanation has too many
inconsistencies to be accepted. His conduct after the commission of
the act is equally irreconcilable with the possession of full sanity.
A virtuous lad betrayed by deadly revenge into such an extreme
would have been seized with an overwhelming flood of remorse and
horror. He would either have rushed wildly away in the hope of
escaping, or he would have betrayed an emotion quite different in
character from what was here displayed. Gabites went calmly and
quietly, and detailed with a ludicrous placidity why he gave himself
in charge. Left alone in the police-cells at Sheffield by night, he
slept soundly. His sleep was uninterrupted by dreams, as his waking
hours were undisturbed by visions of ghastly faces streaming with
blood which he had shed. No pursuing Nemesis rose to his imagi-
nation. He had killed Arthur, and that was all. It had as small
an effect on him as if he had killed a cat or a dog. It is true that
when he had lain six weeks in Armley Gaol he shed tears and showed
emotion when conversing about Allen ; but this was subsequent to
the labours and instructions of the chaplain, who he said, had

1867.] a Medico-legal Study ^ hy De. J. Kitching. 155

taught him much ahout religion, after he had learnt that " Hell
was misery and heaven was happiness/' This subsequently elabo-
rated emotion does not neutralise the indication of the previous
stolidity. Let us make all allowance due to his immature age, and
then ask if it could be possible for a mind in full possession of its
intellectual and emotional faculties to manifest the strange indifference
displayed by Gabites.

All the phenomena elicited by the examination of Gabites, and
the history of his life, lead in the writer's mind to the same conclu-
sions that, in this youth, we have an instance of unsoundness of
mind not coming witliin any legal definition as the law now stands,
but established in nature, and therefore claiming a place among the
great facts for which some provision should be made, when Law and
Nature are thus brought face to face with each other.

It has been often stated in the public journals that the more
general acquittal of persons on the ground of insanity would open a
door for the escape of criminals not insane, and so lessen the dread
of punishment and endanger the safety of society ; also that the
feigning of madness would be encouraged. The fear of encou-
raging crime is, I believe, quite groundless. Men are not generally
anxious to be considered lunatics — even criminal men. But when
unsoundness of mind exists in a criminal, the interests of truth and
humanity require that it should be ascertained; and when it is
ascertained, justice and fairness require that it should be taken into
account in apportioning the sentence to the individual. To assert
that graduating the punishment to the qualified responsibility of the
agent would weaken its effect as a deterrent, and relax the bridle
which restrains other half-demented beings, is a pure assumption.
If various degrees of insanity were recognised in our criminal
courts, and a scale of punishment awarded according to the mea-
sure of responsibility, I submit that the action of the law would be
more certain and satisfactory. The hope of escape would be less-
ened, and its repressive effect strengthened.

The prosecuting counsel in the case of Gabites asked Dr. Williams
if he would venture to sign a certificate for the accused. This was
a perfectly fair and reasonable question. It was put in the hope of
eliciting a negative, and suggesting an absurd discrepancy in the
endeavour to prove a person insane for whom the doctor would not
sign a certificate of lunacy. This is a fallacious, though strictly
legal view of the subject. The signing of a certificate is never re-
quired, in the present state of the law, except for the purpose of
consigning the patient to a lunatic asylum, and is of no force except
under these circumstances. The degrees of insanity now in ques-
tion might, indeed, be declared in a certificate ; but they do not
require the patient to be confined. Many of those persons in whom
they exist are qualified to discharge the ordinary duties of social and

156 The Case of Henrj/ Gabites ; [Jttljj

civil life, and may permanently remain so. So long as nothing dis-
turbs the even tenor of their way they remain harmless and are
accounted sane. But when any event rudely shakes their tottering
reason ; and they are hurried into illegal violence, it is decidedly hard
to visit them with the full measure of punishment assigned to those
who have their reason entire. It is on the occasion when these out-
breaks are either imminent or manifest, and then only, that the recog-
nition of their mental impairment is chiefly required and can best
serve them. On this account the question to be asked and decided
in such cases ought to be, not whether the individual was, previous
to his commission of the act in question, in such a state of lunacy
as to warrant a certificate in its present form being signed for him,
but whether he was labouring under any defect of mind sufBcient
to deprive him of the full amount of responsibility.

There was one feature connected with this trial which differed ob-
servably from all others in which the writer has been engaged, when
a case which admitted room for doubt was the subject of investiga-
tion. The evidence iu favour of the prisoner's insanity was received
by the crowded audience in the court with marked favour. It can
be gathered by other means than words which way the sympathies
of an audience incline. In this case they were enlisted on the side
of the youth's insanity. Whether this sympathy arose from a
clearer conception than formerly of the important truth that there
are many degrees of defectiveness and unsoundness of mind below
those which are embraced in the phraseology of the law, or whether
it was partly due to the juvenile and innocent look of the prisoner,
who appeared to be an unconcerned spectator in the scene, is not to
be determined. I incUne to the former opinion. The prosecuting
counsel endeavoured to disparage the medical evidence both of
Dr. Williams and myself, by an ironical reference to the case of Dove.*

In this attempt he signally failed. Neither judge, bar, nor
audience showed the slightest responsive feeling. Trials like this
cannot but have a beneficial result. The immediate effect upon the
fate of the individual is of comparatively Kttle consequence. Every
such trial gives a wider spread and a deeper insertion in the public
mind to the important truth that unsoundness of mind is of an
infinite variety of shade and intensity, and that below the clearly
marked types of violent madness,'delusional incoherence, and imbe-
cility, there is every degree of mental infirmity and moral incapacity.
No legal definition has embraced these multiform shades of mental
disorder, nor perhaps can it. It is not by any means to be advo-
cated that immunity from punishment should follow the establish-
ment of the slightest degrees of mental impairment. But, on the

* Dove was executed at York Castle. It may be worth recording that the
late Mr. Noble, who was then the governor, said to the writer, " If ever a lonatic
was hanged, Dove was one. **

1867-] a MedicO'legal Study ; hy Dr. J. Kitching. 157

other hand^ it is monstrously unjust that there should be no allow-
ance for any degree of infirmity or incapacity below that of a mad-
ness which the casual and unskilled obser\'er can recognise. That
these truths are gradually gaining ground, and finding more exten-
sive acceptance, has been evidenced by the tone in which the case
of Gabites has been treated in several public journals.*

The harmlessness of the life which the boy had previously led,
the glaring insufficiency of the motive, and the strangely cool way
in which the desperate deed was perpetrated, followed by the delibe-
rate and painstaking surrender of himself to justice by the perpe-
trator, afforded presumptive evidence of the boy's insanity to the
minds of various writers who knew nothing of him personally.

• It was mentioned by the writer, amongst other proofs of a bad memory and
low capacity in Gktbites, that though he had been for many years a scholar in a
Sunday-school, he conld not repeat the names of the first five books of the Bible.
That there should be many adults who have paid so little attention to the Bible
as to be unable to do this is no marvel ; but that an educated gentleman should
think it a capital joke to announce his ignorance in this respect is rather
singular.

The following letter was received by me a few days after the trial :

" Temple ; 21*^ December, 1866.

"Sis, — I have had thepleasnre to-day, for the first time, of discovering that I
am mad, and can commit murder with impunity, inasmuch as I am ignorant of
the order both of the first five books of the Bible and the Ten Commandments.
Two educated gentlemen now with me are also in the same terrible condition ;
sad when the time shall arrive for fulfiUing our destiny, and we make you the
victim, we trust yon will have left for our justification the necessary certificates of
our mstnity. " I am. Sir,

" Yours obediently,

'* * Cantab.'
"Dr. EiTGHiKa,

" The Entreat, York."

U is to be hoped the ignorance so gaily professed by these gentlemen does not
tttend to the contents as well as the order of the Pentateuch and Decalogue.

VOL. Xlll. la

158 On Progremve Locomotor Ataxia; [Jtily*

On Progressive Locomotor Ataxia. By J. R. GAsquST^

M.6. Lond.

The three works whose titles we have placed at the foot of this
article* represent almost entirely our current English lit^ature on
the disease, ' progressive locomotor ataxia/ of which they all treat,
and it is therefore the more unfortunate, and almost provoking, to
find that all three of them, although most excellent so far as they
go, are professedly incomplete in their purpose and scope. Thus
Dr. Althaus has given us a lecture, which is admirably calculated to
give a general notion of the disease to a beginner, but does not
answer many questions which the more advanced practitioner would
ask.

On the other hand, Mr. Clarke presents us with the most inte-
resting collection of cases of ataxia yet made^ connected by remarks
of the highest practical value, although too desultory and detached
to be of much use to any but those who have already studied the
subject.

Lastly, Dr. Bazire, who is doing such good service by his excel-
lent translation of Trousseau's ' Cfinique M^dicale,' has supplied, in
his notes to that work, some very useful information on some points
connected with this disease, but nothing more.

Our object in the next few pages will be, not to attempt to fill up
the void which we have just pointed out; for this we have neither
experience, learning, nor «pace enough at our command. We propose
only to do what we have just quarrelled with Dr. Althaus for doing,
and to endeavour to spread a general knowledge of the disease as
widely as possible, in order that multiplied observation may clear up
(as it alone can) much that is still obscure about its nature and
treatment. This would probably be the result of calling general
attention to the malady here just as much as in France, where so
much that is interesting on the subject has been published in the
last few years.

• 1. * On Epilepsy, Hysteria, and Ataxy/ Three Lectures, by Julius Althaus,
M.D., Physician to the London Infirmary for Epilepsy and Paralysis. (London,
ChurchiU, 1866.)— 2. * St. George's Hospital Reports.' Vol. I, 1866. " On the
Diagnosis, Pathology, and Treatment of Progressiye Locomotor Ataxy," by
J. Lockhart Clarke, F.R.S.— 3. * Professor Trousseau's Clinical Lectures,' trans-
lated, with Notes and Appendices, by P. Victor Bazire, M.D., &c. (London,
Hardwicke, 1866.)

1867.] hy Dr. J. E. Gasqubt. 159

There are really no grounds for supposing that the disease is
notably (if at all) rarer in England than in France. Every prac-
tical man, on first reading an account of ataxia, will recaU cases
which he had diagnosed to be intractable rheumatism, amaurosis, or
paraplegia, but which, when reconsidered, seem to have been ataxic
in their symptoms and character.

Nor could such a man take much shame to himself for his past
opinions; for, up to the year 1843, when Dr. Todd (in the ^Cyclo-
]p«Bdia of Anatomy and Physiology') first clearly pointed out that
there were cases in which muscular power was not lost, and yet the
movements of the body were very irregular, no scientific know-
ledge of the disease we are considering was possible, since its most
important symptom was unrecognised. Its pathological anatomy
had, however, been described by Jacoby (one of the school of Rom-
berg) in 1842, and this was followed up, after an interval of ten
years, by Tiirck and Eokitansky; but the disease itself was still un-
distinguished from paraplegia, muscular atrophy, and " tabes dor-
salis,''* so that, in spite of Romberg's having distinguished between
the symptoms ataxia and paraplegia,t Dr. Gull deserves full credit
for originality in his description of the first well-observed case, in
'Gu/s Hospital Reports' for 1858.

Dachenne followed closely upon this with a tolerably complete
history of the disease ; for which we may hardly be inclined to agree
vith Trousseau in naming the disease after him, but which we must
admit to be the greatest advance made up to that time. This had
the further advantage of being taken up by Trousseau, who gave a
good idea of the ' symptoms and course of ataxia to the numerous
readers who studied with eagerness the ^ Clinique Medicale' of that
great physician ; consequently, in the* last few years many efforts
iave been made in France to acquire a more correct knowledge of it,
and although these have led their authors in some instances to very
Cerent conclusions, yet the progress made there has been on the
whole very decided. In England less has been written, and less
attention paid to the subject, but it is evident that a generally cor-
rect notion of it is widely diffused; while, on the contrary, in Ger-
iDany the unfortunate association of the disease, on its first descrip-
tion by Romberg, with ^ tabes dorsualis,^ has led to its being
confused, by some of the best-informed German physicians, with
several other diseases.

We will now describe briefly the symptoms and course of the
disease, premising that it is much more common in men than in

* " Dorsualis," as used by the Qermans, is the more classical form of the adjec-
tiTe.

t In the description of *' Tabes Dorsnalis" in the edition of his great work for
1857.

ICO On Progressive Locomotor Ataxia; [July>

women (M. Topinard gives the proportion as 81 males to 33
females ; Eisenmann, 50 males to 20 females) ; that it is very rare
in early youth and in old age; and that most of those who suffer
from it have been frequently exposed to cold and damp. Either '
without any other obvious cause, or after a cold distinctly caught,
the first symptoms of the disease occur.

Duchenne has divided these (and his division has been followed
by most subsequent writers on the subject) into three stages.

The first stage is characterised especially by pain, and by symp-
toms which point to the encephalon. The pains, which, according
to Mr. Lockhart Clarke and most observers, are the most constant
and earliest phenomena, are generally neuralgic in character, very
sharp, lancinating, and only momentary, like a frequently repeated
succession of electric shocks. Or, again, they may be dull, aching,
rheumatic, and are then usually confined to one spot, and relieved
by pressure or rubbing.

Of whichever kind they may be, they very often begin in the
lower extremities, wander over the body, and finally settle in one
leg or thigh, whence they proceed upwards ; in niany cases, how-
ever, their progress is quite irregular. They sometimes assume the
form of painful constriction of the thorax, abdomen, or thighs.
They are generally increased by excess in walking, drinking, or
venery, or by constipation ; and, still more notably, by cold and
damp weather. So marked is the influence of the state of the atmo*
sphere, that these patients dread the autumn and winter, and are
very much better in summer and spring.

Generally, after these pains have been in existence for some time,
but sometimes without their having been noticed at all, symptoms
may be observed which show that the encephalon is involved. In
very rare cases the disease has begun by violent headache, vertigo,
photopsia, and tinnitus aurium (M. Carre's " cerebral'^ variety) ; in
others (as in a case recorded by Trousseau) temporary hemiplegia
may occur.

But, much more frequently, mischief is indicated by paresis of
some of the cranial nerves. The second, third, and sixth nerves are
those most often affected, the commonest symptoms being therefore,
in their usual order of occurrence, strabismus (generally iijtemal),
ptosis, diplopia, amblyopia, and amaurosis.

On examining the affected eye with the ophthalmoscope at an
early stage of the disorder, the capillaries are observed to be con-
gested, the whole fundus being darker than is natural, but by
degrees the retina becomes atrophied, is of a greyish colour, and
surrounded with a white circle.

With regard to the state of the pupils, Romberg says that he has
frequently found them contracted to the size of a pin's point in

1867.] hy De. J. E. Gasqubt. 161

" tabes dorsualis /'* and it would appear from Mr. Clarke's cases
that this is the rule when the ocular nerves are otherwise unaffected ;
but ptosis and strabismus are more generally accompanied with
dilated pupil.

A curious alteration of vision has been occasionally noticed; the
patient has been found to see two images with one eye only open^ or
three with both open.

The othar cranial nerves are much less frequently affected. Dr.
Althaus says that the olfactory never is, but Mr. Clarke gives one
case in which the sense of smell was almost entirely lost.

Almost all these affections of the cranial nerves disappear after a
short time, with or without treatment, except ptosis and amblyopia^
which usually go from bad to worse.

Spermatorrhoea, ending generally in anaphrodisia and impotence,
is a very common symptom, but in a few rare cases (as Trousseau
lias especially noted) sexual desire and power are morbidly great.
The bowels and bladder are generally sluggish ; indeed, in one case
which came under our own observation, retention and involuntary
evacuation of urine was one of the most prominent symptoms, but
this is rare. In aU other respects the health seems to be unaf-
fected.

With regard to the proportion of cases in which the early symp-
toms appear, statistics are as yet very imperfect. In 28 cases out
of 125, collected by Topinard,t the cranial symptoms were entirely
absent; in 14 out of 63, according to M. Carre, they preceded the
pains, while in the remaining 49 we may suppose that the pains
occurred first.

The average duration of this stage of the disease is from four to
five years, but this is very variable, and a very few cases are recorded
in which all its phenomena were absent, and the disease began ab-
ruptly.

The second stage is marked by the occurrence of the most im-
portant symptom of the disease, viz. irregularity (or "ataxia'^) of
movement. Of this, as Mr. Clarke has pointed out, there are two
distinct forms. In the earlier form there is mere unsteadiness of
the limbs affected ; the patient staggers and totters, especially on
first beginning to walk or on turning round; he adopts various
expedients to maintain his balance ; he cannot stand with his eyes
shut and his feet placed together, and, as the disease advances,
cannot stir without keeping his eyes fixed on his feet. When the
upper extremities are attacked, no delicacy in the use of the fingers
or arms is possible.
In the second form the motor disturbance is exhibited in spas-

♦ 'Nervenkranheiten/ Bd. i, Abth. 3, p. 684.
t * Union Medicale/ Mars, 1865.

162 On Progressive Lo€omotor Ataxia ; [-Tuly^

modic movements of those muscles which \ht will intends to put in*
action. The limbs are flexed^ or extended with a sudden violent
jerk ; they are strangely thrown about ; the patient can no longer
walk without support^ and^ when the disease reaches the muscles
fixing the pelvis^ can no longer stand at all^ though he may be
capable of exerting great force with his legs while sitting or lying
down.

These two forms are evidently produced by different d^rees
of one morbid state — absence of co-ordination of the muscles.

In the former case the motor irregularity is owing to an inability
to combine properly the numerous muscular contractions which are
requisite for even the simplest movement; in the latter the natural
harmony between the antagonist muscles^ which is one of the
elements of normal co-ordination^ is also abolished ; the flexors or
extensors alone act. whence the jerkinc: and violent movements.

In the immense majoritj of (4es iL striking symptom begins in
the lower limbs^ and spreads upwards from them ; in only two in-
stances (one recorded by M. Carre, the other by M. Vemay) it began
in the upper extremities, in the latter case remaining confined to
them, but in the former spreading downwards.

A certain loss of muscular power is sometimes complained of by
patients, although it cannot be detected by the physician; and in-
voluntary twitching (especially of the fingers) is not uncommon.

Cutaneous hypsesthesia (numbness) is an ahnost invariable
symptom of this stage of the disease. It generally begins, and con-
tinues to be most noticeable, in the soles of the feet and the legs,
whence it spreads to the thighs ; in the upper extremities only the
third and little fingers are afiected^ As the disease advances the
numbness goes on, in most cases, to absolute anaesthesia; or sensi-
bility to pain may be entirely lost, the sense of touch remaining
intact, or sometimes sensation may be very tardy or obtuse, or the
patient may be unable to tell in what part of the body he is
touched; for aU these varieties have been noticed.

The sense of pressure or weight is also frequently very blunt;
while, on the contrary, that of temperature is seldom affected.

In rare instances there is great hypsesthesia, the slightest touch
then producing extreme pain.

Eeflex movements are usually excited with difficulty ; but, in one
remarkable case of Mr. Clarke's, '* although the feet and legs were
almost completely deprived of the sense of touch and pain, yet their
surfaces were so susceptible to excito-motor impressions, that the
slightest touch or brush threw the whole body into motion, and
caused the patient to jump almost from his chair.''

The last of the three periods into which Duchenne has divided the
disease is simply the termination of the second. All the symptoms
become worse, and the patient is hopelessly bedridden. From this

1867.] by De. J. E. Gasqubt. 163

cause^ and to a less degree from slight paraplegia^ the muscles begin
to lose their power ; they become atrophied, and partially degene-
rated into fat. Painful spasms frequently occur in the affected
limbs, and are among the most troublesome symptoms of this stage
of the disease. The urine is retained, or is passed involuntarily ;
and either this, or sloughing of the back, is the most common cause
of death.

The duration of the disease, from the first occurrence of ataxia of
movement until the fatal termination, is very variable; it is often
ten years, or even more.

The diagnosis of the disease is generally easy enough when it has
passed into its second stage; but, before motor disturbance has
Dcen percdved, it is difficult, and very often impossible. The cha-
racter, seat, intractability, and progress of the pains, will guide us to
a suspicion of their nature, which will be heightened if ocular symp-
toms, especially strabismus and amblyopia^ combined, be also pre-
sent.

Even when ataxic symptoms are fully developed, it may be dif^
ficult to know whether these signify the existence of the disease we
are speaking of, or that of some one of the other numerous affections
in which unsteadiness of gait occurs. The following points will be
the most important for a correct diagnosis. Unless the early history
of the disease be quite unknown, we may at once set aside hysteria
(which can make an excellent imitation of the symptom ataxia) and
chronic alcoholism. General paralysis (in England at least) is
almost always accompanied by its characteristic mental disturbances,
and the motor irregularity extends to the face, tongue, and lips.
There is also apparently real loss of muscular power, although
Bouillaud, Wunderlich, and Dr. Skae consider that there is no
actual paralysis, but only ataxia.t Syphilis may bear a closer
resemblance to many of the symptoms of ataxia ; but in a doubtful
case the iodide of potassium would of course be tried.

Disease of the cerebellum is also attended with a tottering gait,
which might easily be mistaken for ataxia, with strabismus and am-
blyopia; out these symptoms do not generally preserve the same
order of appearance as in ataxia. The irregularity of movement in
cerebellar disease is also shown by epileptiform convulsions, and
"mouvements de manege/' there is generally difficulty of speech,

* Dr. Hnghlings Jackson stated, and Mr. Clarke has repeated, that the
ophthalmoscopic appearances of amaurosis from ataxia are different from those of
imanrosis from cerebral disease ; but this would appear not to be the case. See
a letter from Dr. Althaus in the 'Lancet' of June 17th, 1865.

t Jaccoud quotes three remarkable cases, in which, shortly before death,
patients who had long been suffering from ataxia presented symptoms of general
paralyds (" d^ire ambitieux"). Had we more details ^ven, these cases might
lead to clear up some of the obscurity attending the form of general paralysis^
where motor signs precede the mental disturbance.

164 On Progressive Locomotor Ataxia ; [July,

vertigo, fixed pain in the back of the head^ and vomiting ; none of
which symptoms form part of ataxia.*

On opening the vertebral canal after death the membranes are
often found to be thickened and opaque, and the pia mater adherent
to the posterior columns ; these appearances are observed in about
one half of the autopsies, according to Dr. Althaus. The back of
the cord looks flattened, and the posterior median fissure is generally
obliterated. The posterior columns, instead of being white, are
either entirely grey and semitransparent, or are streaked with bands
of that colour, running up and down the cord. This change is most
common and most distinct in the lumbar region, and in advanced
cases has been seen to extend as far forward as the lateral columns,
but the anterior ones are never involved. If a section of the cord be
made, this grey colour is perceived to be not merely superficial, but
to affect the posterior columns, wherever it is apparent on the sur-
face, in their whole depth. It is also noticed that they are decidedly
smaller than natural. When the* cord examined is in an early stage
of the disease, the affected portion is found of the normal consistence,
or even softened, but in the great mass of more advanced cases it is
unnaturally hard, almost as much so as a brain steeped in alcohol ;
hence the name '^ sclerosis,'^ which has been given to the disease.

The posterior roots of the spinal nerves in the part diseased, and
the nerves composing the cauda equina are almost always similarly
affected ; and, in twenty-one cases out of forty-eight, the posterior
cornua of grey matter have been found in the same state. I^his
much, at any rate, would seem to be invariably the rule in the ver-
tebral canal, that the disease spreads from the posterior columns of
the cord as a centre. On the other hand, as Mr. Clarke has espe-
cially pointed out, such changes as are remarked in the encephalon
seem to spread from the distal extremities of the cranial nerves
towards their centre. Thus, the optic nerve, chiasma, and tracts
are frequently sclerosed; sometimes the corpora geniculata, and,
more rarely, the corpora quadrigemina. The other cranial nerves
are but seldom affected. The cerebellum, owing to the part it has
been supposed to play in the co-ordination of muscular movement,
has been almost invariably examined, and found healthy.

Microscopical examination of a portion of diseased cord shows
that, in the early stages, the nerve-tubes are diminished in number
and size, and granular bodies, produced by their disintegration,
appear. As the disease advances, and the atrophy of the nerve-
tubes becomes more and more marked, their place is taken by fibres
of ordinary connective tissue, by nuclei, and by small cells (Eobin^s
'^my^locythes'^). The capillaries are often thickened or atheroraa-

• See papers on " Cerebellar Disease," by MM. Leven and Ollivier, in ^Archives
Gen. de.M^d./ 1862 and 1863. Mr. Clarke mentions a case of ataxia, in which
vomiting was a prominent symptom.

1867.] hy Dr. J. E. Gasquet. 165

tous, and they are frequently surrounded, in long-standing cases, by
oil-globules or corpora amylacea. The anatomical change, there-
fore, consists essentially of two parts — 1. Diminution of the nerve-
tubes, in both number and size. 2. Development of adventitious
products. The former of these changes only is noticed in the pos-
terior roots of the spinal nerves ; but the cranial nerves have been
found generally to contain new products, the corpora amylacea
beii^ especially abundant in the optic and hypoglossal.

When the grey matter of the cord, or of the gangha in the pos-
terior roots, is involved, the nerve-cells in it are almost invariably
found healthy.

As to the connection between the anatomical state we have just
described and the symptoms, the following is the most probable
explanation. It would appear that by the destruction of the pos-
terior fibres of the cord the sensory nerves which supply the mus-
cles are cut off from the spinal motor centres, which are now
believed to be the centres of muscular co-ordination, and that thus
ataxia is produced. The hypsesthesia which is so generally a
symptom of the disease is probably owing mainly to the destruction
of the nerves themselves, and only partly to the sclerosis of the
cordj for we have every reason to suppose that sensory impressions
are conducted up the grey matter of the cord, which is generally
tDtact in this disease.

The cause of this remarkable anatomical change, which affects
at the same time the cranial nerves and the lower part of the
spinal cord, is as yet unknown to us. We may compare loco-
motor ataxia, on the one hand, with cases of paraplegia produced
by exposure to cold and wet, or by urinary disease ; and, on the
other, with instances collected by Dr. Handfield tfoues (in the
appendix to his 'Functional Nervous Disorders^) of retinitis,
amaurosis, and paralysis of various cranial nerves caused by remote
irritation. The same author has also shown it to be very probable
that symptoms of the same kind as those we have been considering
may be produced, without any organic disease of the nervous cen-
tres, by the diatheses syphilis and rheumatism. These analogies
would lead us to ask whether the cold caught (which most ataxic
patients speak of as the cause of all their ills) is not really capable,
given some special predisposition, of producing this disease, either
by checking the secretions, or (to borrow Dr. H. Joneses phrase) by
its directly " inhibitory ^^ influence.

What the special predisposition may be is as obscure in this as in
most other diseases. At any rate this seems to be established, that
sexual excess or abuse has little or nothing to do with it. Probably
the only reason why some connection is still presumed to exist, by
most men, between these vices and progressive ataxia, is because
there is still a confusion in their minds between this disorder and

166 (hi Progremve Locomotor Ataxia; [J^Vi

'^ tabes dorsalis/' a name which includes all cases of exhaustion of
the cord by venereal excess. The great majority of ataxic cases pre-
sent no history of anything of this kind, but^ on the other hand^
Soint very decidedly to habitual exposure to cold and wet as the pre-
isposing cause.

Many German^ and some few French writers, of whom Jaccoud is
the most prominent^ have laid undue stress upon the anatomical cha-
racter of the disease^ and have looked upon it as being essentially a
sclerosis ot the spinal cord ; but this view is generally condemned
by those who have observed the cranial symptoms which^ in a great
majority of cases^ are part of the evolution of the disease. Thisi
much only can be said in its favour, that the cord may be sderosed
in many other different affections,*^ especially in the disease known
as " spedalsked/' of which motor ataxia is an early symptom.

We have fortunately passed the time when fiomoeEg could write
with truth these despairing words: — ''No patient suffi^ng from
this disease can be cured; death awaits them all; and the only con-
solation which can be given to those who love life, is the long dura-
tion of the disease.^^ We condemn as emphatically as he does the
useless cruelty of repeated issues, setons, and bleedings ; but these
are plans which no enlightened practitioner at the present day is
likely to adopt, and we are firmly convinced that judicious treatment
can do much, generally to relieve, sometimes to cure, those suffering
from ataxia. Unfortunately the disease is seldom or never diagnosed
until extensive destruction of nerve-tissue has taken place; but in
this respect we may hope for improvement as it becomes better
known.

Under the head of remedies which have been tried and been
found of no avail, we may mention opium, bromide of potassium,
and secale comutum. But at least they have done no harm,
while strychnia has never done any good, and, in one case re-
corded by M. Carre, produced violent pain; iodide of potas-
sium, too, has appeared in some cases to accelerate the course of the
disease.

The vapour, lamp, and Turkish baths have also disappointed the
well-grounded hopes which had been placed in them ; but sul-
phurous baths and electricity are especially commended by Dr.
Althaus as palliatives. The severe pains of the first stage are
relieved by belladonna, cannabis indica, and oil of turpentine, inter-
nally, and by dry-cupping over the neck and back.

Eisenmann found decided benefit in four cases of ataxia from the

* Thus M. Charcot, hesides those cases in which the disease has spread from
the posterior colamns of thje cdrd, has found it in the lateral columns only (in
two cases of permanent modular contractions in hysterical patients), and in cir-
cumscribed patches, distributed through the cord irregularly. — (' Union M^cale,'
9 Mars, 1865.)

1867.] hy De. J. E. Gasquet. 167

regular use of gyjnnastics ; this is at any rate worth remembering as
an adjuvant to more active treatment.

But the only remedy which has ever obtained any considerable
reputation in the treatment of this disease is the nitrate of silver,
mtroduced by Wunderlich. It is difBcult, as in all other questions
of therapeutics, to make out its precise value ; but it would appear
to have every chance of being successful when employed at an early
period ; and, when it fails, it seems to do so cither from being given
too late or without sufficient perseverance. The good effects it pro-
duces are too frequently only temporary; hence probably its prolonged
exhibition, is advisable. Of course the usual precautions will be taken
to prevent its colouring the skin, or disturbing the stomach, bowels,
or bladder. Dr. Althaus combines with it the hypophosphite of
soda, which he considers beneficial.

Arsenic, which would on theoretical grounds be recommended,
has been tried several times, but with partial success in one case
only, recorded by M. Teissier ; we confess that we should ourselves
be very strongly disposed to give it a further trial.

M. Carre conjectures that possibly the internal administration of
the Calabar bean might do good. We do not see grounds for put-
ting any faith in it, and, if we may ourselves hazard similar guesses,
would rather suggest aconite as likely to relieve the pains, and
conium as being possibly a curative agent.

It is needless to add that the general health should be kept up
by good food and tonics, cod-Kver oil being especially valuable,
considering the relation of fatty bodies to the nutrition of nervous
tissue. T^e bowels should be kept well open, for this alone will
frequently relieve the pains of the first period of the disease. In
spite of the truth of Eomberg's remark that long journeys are in-
jurious to these patients, we should be inclined, seeing the improve-
ment in the first stage efilected by warm weather, to send those
whose circumstances would allow it to winter in some tropical or
semi-tropical climate.

168 [July,

Introductory Lecture to a Course on Psychiatry, delivered at the
Imperial Joseph Academy in Vienna, November, 1866. Bj
Baron J. Mundy, M.D., Staflf-SurgeoD-Major in the Army of
His Imperial Majesty the Emperor of Austria ; Membre Associ^
Etranger de la Soci^te Medico-psychologique de Paris, &c.

Upon the noble ship of medicine, which sails proudly on the
ocean of knowledge, decked out with gay and varied flags, there
floats, my honoured friends and colleagues, one banner inscribed
with the word " Psychiatry." It is, I might almost say, the last
one added and the lowest in position. For although in the future
we may hope that it will be uplifted higher, and acquire more and
more prestige, so as probably at length to range itself on a level
with its auxiliary sciences, with pathological anatomy, physiology, and
practical medicine, and with other specialities of this last, as a worthy
equal with them, yet, alas ! this happy event is not yet realised !
Still, my friends, we must feel impelled to advance further and fur-
ther along the new road that we have entered upon — ^that practical
and positive path whereby alone we can attain to that goal at which
we aim, the goal of truth and perfection. And, in fact, my friends,
if I to-day, in this introductory discourse, do not unveil before you
the dreary picture of the past in respect to this science of psychiatry
— if I withdraw from memory all those dark deeds and barbarities
that prevailed of old, and gladly let oblivion cover them, it is with
the view that I may do homage to progress, and thereby place
myself in harmony with you ; for the purport of our inquiry into
this science of psychiatry is, to find not what was, but what is, and
still more what shall be, and what shall be for the better, and at the
same time to investigate and advance it. In considering to-day the
principles (stand-point) of this science, I shall therefore, first of all,
take up that division which is known as clinical psychiatry.

You are aware that clinical psychiatry is, in comparison with
clinical instruction in other branches of medicine, very little '
attended to, and is also consequently not so often undertaken as
might fairly be desired and as it has a claim to be. The reason of
this is a simple one. Its clinical study stands aloof; it is not
readily accessible ; it is not so free, independent and diversified, and
it is not so public, as clinical medicine or cUnical surgery. You
will, moreover, in the course of your medical experience, have
remarked that when a patient, in attendance either in the out-door
or in the in-door clinique, perchance exhibits symptoms of that dis-

1867.] Introductory Lecture to a Course on Fsi/chiatry. 169

order which we designate insanity, he is as speedily as possible
transferred to the lunatic asylum as the only suitable place for his
case. Clinical teaching in psychiatry, though you may desire it, is
consequently, as a rule, only accessible in a lunatic asylum, to which
it has hitherto been the custom to allow admission to visitors as
few in number, as seldom and for as short a time, as possible.
Whence it happens that, though you would be held to blame for not
knowing how to proceed with any case in any other special depart-
ment of medicine or of surgery, you would at the present day be
deemed excusable if, when called upon to deal with a case of psy-
chosis, you should find yourselves inexperienced and ignorant re-
specting it. Those who are military medical oflBcers, and therefore
often stationed in outlying places, where no other professional man
is to be found, would be sorely blamed if they did not understand
and carry out even the most serious operations, or a difficult labour,
the operation for hernia or laryngotomy, or if they were not fully
acquainted with every usually recognised branch of practical medi-
cine, and yet at the same time they would be as readily forgiven
should they not know how to treat a lunatic. This illustration
is sufficient to indicate how important it is that this branch of
practical medicine should be cultivated, and how much it is the
duty of the physician of the present day to make himself acquainted
with it. The hand-books of psychiatry hitherto published, although
they offer a mass of valuable matter, and are very carefully compiled
bj their several authors — and it is known to those who have studied
at the larger universities that the local psychiatrist, as a rule, con-
siders it his business to prepare a text-book for his class — ^yet they
are always unsatisfactory to the practical physician. You can also
understand that a hand-book cannot always convey to you the teach-
ings of practice. In short, the field of practical psychiatry must be
cultivated afresh, and be sown with good seed, and all physicians be
enabled to reap the fruits.

In its legal relations, also, the necessity for a knowledge of this
special science is easily perceived ; and if you — as may so often and
readily occur in your practical medical studies and occupation —
should be called upon as experts to give evidence in a case of
insanity, you would be at once convinced of the importance of a know-
ledge of mental disorders in their forensic bearings, and of being able
to form a correct estimate of all details according to the newest

Erinciples of the science. But should you by no such considerations
e induced to devote yourselves (which, for the honour of science, I
vill not suppose) to the speciality to which for a long period I have
dedicated myself, yet you will recognise the duty that must often de-
volve upon you, as practising physicians, of understanding this branch
of medicine in its therapeutical relations. Lastly, if the manage-
ment of the insane may have hitherto been to you a matter of indif-

170 Introductory Lecture to a Course on "Piyekiahry ; [July,

ference, yon may nevertheless consider it to be an admitted fact that
this subject^ as heretofore conducted^ and so far as it does not rest on
that basis which for the future must be accorded to it — ^that, I say,
psychiatry in its administrative relations must surrender many things
still attaching to it, and must renounce many prejudices that have
up to the present time clung to it. Proceeaing upon these prin-
ciples, thus briefly sketched, I shall furnish you a secure and true basis
for the series of lectures I propose to deliver. Upon taking a nearer
survey of this basis, I shall have occasion to speak to you again of the
clinical, legal, therapeutical, and administrative relations of psy-
chiatry, as understood by, if I may use the term, the "new school.' To
the building up of this new school I make no pretensions as a con-
tributor, for my personal importance in the matter is of very small
account ; but it lias been established by men who have had the
advantage of cUnical experience during the last thirty years in this
speciality, men who also enjoy the highest reputation in science in
general, and behind whom I have no need, as it were, to barricade
myself, and who are likewise authorities in medicine. You may,
indeed, inquire why I have not adopted as the subject of my lecture
to-day the history of psychiatry from the oldest time until the pre-
sent period, and why I do not recount the names of these men in
triumph.

My friends, the plan I have struck out is the reverse to this.
These names, which possibly you may just now long to learn from
me, will be often cited by me in the course of these lectures in their
suitable places, whilst if heard at the present moment they might
soon fade from the memory. The history of psychiatry will, however,
be displayed before you in all the phases of its growth, and, indeed,
if you have condescended to read through my programme of these
lectures, you will have observed that I have deferred the history of
psychiatry to the close of my course, when those names will be
thankfully greeted by you as those of beloved acquaintances.

If you now ask me, as you very rightly may, how and wherein the
principles of the science at this modem period are to be sought, I have
in reply to reiterate what I have already stated. In the first place,
they are to be sought in the clinical element already insisted upon as
requisite. Clinical instruction, my friends, as at present conducte^i
does not, for the most part, meet the requirements of the case.
Trom the general remarks made you will have gathered that it does
not supply what is demanded. The clinical study of psychiatry should
in future be public, available to all, like other clinical courses, and
should be pursued in the chief towns, or in places where a university
is founded, where both instruction and material for it can be ob-
tained. For this purpose apartments for prosectors should be pro-
vided, such as, indeed, have been established in some towns, together
with an unrestricted supply of material for the end in view, so that.

1867.] ly Baron J. Mundy, M.D. - 171

as is essential^ the theoretical lessons of the lecture-room may be
there practically exemplified. The teaching must be rigorously
sifted and purified from all those conditions which at the present
wre found connected with lectures on psychiatry and with the
practical demonstrations^ which cannot be adequately illustrated by a
aisprc^ort^nate number of chronic cases. In truths would you not
be astomshed at a surgical clinique if patients with united fractures
or labouring ujider chronic disease w^e the only examples brought
forward for the purpose (rf practical instruction ? And so you find
that in hinatic asylums the aggregation^ the multitude^ of patients
does Bot tifford you means for discovering those subtle difi'erences
which you, above all, require for forming a correct diagnosis and
prognosis — ^I mean in acute and chronic cases. It is an old and
true proposition that the series of pathological changes which have
beefi discovered in the insane leave it a difficult task to distinguish
a recent case from an old- standing one by the morbid changes
existing. But even if the patients were collected in groups, and
arranged in classes having no scientific basis nor capable of exact
definition — however rich they might prove in tables, figures, and con-
dusions, though, nevertheless, very poor in results — ^it would be easy
to show that it would be barely possible for the student to distinguish
acute &om chronic cases, and to study them in a satisfactory manner.
Consequently the clinique of the future, according to the wishes of
those whose opinions are valued, should present a limited number of
patients, and from this restricted number intended to afford instruc-
tion the professor of psychiatry would select the most instructive
among them, and, after a theoretical statement relative to the patho-
logical, anatomical, and physiological features of the cases in their
varied relations, would practicaUy demonstrate the psychosis in the
patients themselves. This would constitute a great advance, and it
wonld be well, my friends, if all agreed with me on this matter.

The second direction in which psychiatry should make progress is
in the way of its legislative (legal) bearings. Legislative hopes for
the future in reference to these relations are great. Just as the
st^ruggle at present is arduous to promote decentralization in matters
of administration, and as much effort is needed to institute a system
of therapeutics based on the newest principles of dietetics and the
laws of hygiene, so like strenuous endeavour is required for instituting
salutary rules for the management of the insane. But there is no
longer need of many and persuasive words to convince you of the duty
of procuring the entire abolition of that principle of restricting the
movements of the insane and of the plan of sequestration, which has
constituted the fundamental law in lunacy legislation ; for this prin-
ciple must always operate injuriously upon all those conditions (fac-
tors) which are needed to promote a sound state in ordinary persons,
and still more in those afflicted with disease. It is, in truth, no mere

172 Introductori/ Lecture to a Course on "Psychiatry ; Puly,

fancy, but a fact based upon one of the greatest examples^ of which
I shall hereafter have the honour to speak, that free movement, the
unimpeded power of enjoying light, air, and warmth, the participation
in family life, with all tne other conditions of existence, in a word, the
laying aside of that apparatus of restraint, which has hitherto prevailed
so powerfully in the treatment and management of the insane, and
does even still prevail more mightily in legisktion — this renunciation
of restraint, I say, has wrought the best and most important results*
And I may here remind you of a colony of insane of which I have
hereafter to speak at large — I mean, Gheel, in Belgium, where up-
wards of a thousand lunatics live free, without restraint, among the
ordinary inhabitants, reside with them, cultivate with them the fields
and farms, resort with them to church and school, act as nurses for
their children, and lead an ordinary, natural family existence, such
as we are accustomed to value in our own homes. But another more
important matter in legislation is that, by reason of the necessary con-
ditions for such freedom, the lunacy laws must undergo a complete
transformation, and a new code, based upon this principle of freedom
and the absence of restraint in the treatment of the insane, must be
established. That such a course is practicable I may illustrate
by another brief example, namely, that in England a population of
50,000 insane in asylums are managed without resort to restraint;
and not only is this the case, but the Parliament has elevated the
principle of non-restraint to a legislative act, whereby the physician
who should impose restraint upon the insane is rendered liable to
prosecution and is exposed to the loss of his appointment. This
mode of treatment of the insane, which is known by the name of
^' non-restraint,'^ and which has been energetically, though without
any reason, opposed in Germany and elsewhere, owes its establish-
ment to a man whose loss science has lately had to mourn. You
will allow me to-day here to mention his name — it is John Conolly,
the first psychiatrist of England, but who also deserves by his merits
to be called the psychiatrist of the world.

It is readily understood, my friends, that as the condition of the
insane is prone to vary so remarkably when viewed in connection
with legislation, it must also clearly undergo changes in respect to
administrative details. As it now is my desire to establish in a great
city, possessing a university, a clinique for the education of psychia-
trists and practical physicians, the same course must be followed as
in the case of the majority of other chronic maladies, and psychiatry
must be considered under two heads — the teaching and the adminis-
trative— ^instruction and practice. When we have to deal with a
so-called/ai^ accompli^ in the shape of a chronic case, where no hope
of cure remains — when we have hereafter reached the subject of
prognosis we shall there recognise, as, indeed, we have in some
measure recognised, a de facto distinction between curable and

1867.] by Baeon J. Mundy, M.D. 173

incorable cases) — we must pursue a diflferent course with this in-
curable case than with one in respect of which we have the best
hopes of recovery, and as one aflfording material for clinical in-
struction. These so-termed incurables, when they are poor — and I
throughout am speaking of the public provision for the insane —
must as often as possible, both for their own sake and for those who
pay for them — ^the taxpayers — ^be made productive or remunerative.
Ve must therefore not lodge such in the city in a magnificent
palace, as is even now done, and detain them in a state of idleness,
but employ them upon the land, or in the handicraft to which they
have been trained, or turn them to account in any sort of occupation
for which they have the capacity. The administrator would occupy
his position in the institution, which may be caUed an asylum or
industrial establishment, whilst the teacher would have his clinique
in iiie city. The provinces should thereby be no losers, for the
clinical material of the provinces would be also turned to scientific
account in -the hands of a weU-trained psychiatrist, who would be
at the same time in a better position, m the discharge of his ad-
ministrative functions, to profitably develope the industrial resources
of the institution with greater ease and success.

The therapeutical element will also be a gainer ; for we by the
same means arrive at a systematically disposed clinical treatment. And
the question may here be put, wherein does the treatment of mental
disorders consist ? The brief answer I shall make is, that it consists
in precisely what in practical medicine the treatment of a patient
consists. As at the present time aU psychoses are excluded from
the several courses of clinical instruction, it happens for the most
part that the general physician recoils from a case of lunacy because
of its novelty to him, and of its obscurity, in face of its mechanical
treatment may I say, and he says to himself, I know nothing what-
ever of the various symptoms and changes which the patient may
undergo betwixt to-day and to-morrow, or between to-morrow and
fte day after ; I also do not know the danger : on the other hand, I
am oUiged by the law not to neglect my duty towards him, and
therefore I must give up the patient and transfer him to the only
plaee which has for its special object the treatment of the insane.
But when the physician in general practice has acquired besides
the ordinary principles of practical medicine a knowledge also of
mental diswders, and will trust himself with the external remedial
measures necessary, he wiH arrive much more readily at a correct
judgment respecting the case, and will only transfer his patient to an
asylum for specid treatment when from his thorough knowledge he
recognises the patient to be dangerous to himself or to others.

If we examine somewhat more closely and in detail the origin of
the lesions in psychoses, we arrive first of all at a class of disorders
which exhibit themselves in connexion with the bram and have their

VOL. xin. 13

174 Introductory Lecture to a Course on Psychiatry ; [July,

seat there. Now, you all know well enough that general practical
medicine undertakes the consideration and treatment of the whole
series of diseases of the brain in its widest acceptation. You come
further to other disorders, which partially have their seat in other
organs or tissues, as for instance in the nervous and in the urino-
genital apparatus, and lastly, in all those parts which must have
been studied by you in their pathological connexions, as the spleen,
the liver, the stomach, the intestines, &c. When you, therefore, par-
ticularly in this speciality, will give yourselves the trouble to learn,
with the same zeal and assiduity you manifest in other departments
of practical medicine, and when you have made yourselves accurately
acquainted with the diseases of the brain, and all the pathological
changes belonging to them, and have studied those of the nerves and
central organs, you will gain by means of this information a know-
ledge of the lesions, and therewith a practical knowledge of the psy-
choses accompanying them.

You will only further need described to you the heterogeneous
phenomena which immediately appertain to the speciality known as
psychiatry, in order to gain that practical experience of cases of in*
sanity which for the most part was not brought under your notice
in the history of pathology taught at a former period in your clinical
instruction. The diseases which primarily involve the psychoses are
those of the brain and nerve-apparatus ; these we are called upon to
deal with in the circle of our rough observation, and I must to-day
deplore that in the course of my remarks I shall not be able to
make use of material that will enable me to demonstrate to you upon
the dead-subject and preparations, in its anatomical and physiolo-
gical relation, that which I have laid down as the prolegomenon for
the theoretical part and as likely to be found necessary.

The theoretical part of my subject is that which it will be the
more convenient to restrict ; and the more so, since I wish thoroughly
to consider the clinical portion. I shall, consequently deem it my
duty to lay before you the theoretical as often as possible in con-
junction with practical instruction, and discuss it with somewhat
more rapidity than is the custom. Diseases of the brain, diseases of
the nerves in aU their ramifications, — I might say in their mysterious
ramifications, for you know only too well that more than the usual
degree of mystery and obscurity attaches to cerebral disorders, —
these, as exhibiting themselves in connexion with psychoses, will
constitute a subject for our earnest consideration in their manifold
relations. Nor must we in treating that subject forget to notice the
great progress which has been accomplished in a field heretofore
lying fallow, by the elucidation of late years of the pathology of
degeneration. This modern important doctrine bids fair to con-
tribute largely to the purposes of practical pathology; for it is
evident that, though not many, yet some laws of the highest im-

1867-] by Baron J. Mundy, M.D. 175

portance may be deduced from it. It would not, I believe, be
difficult to persuade you that it happens that, in this science above
all others, we are in a position to establish laws upon actually
observed phenomena and on experience, to which we thereupon assign
a definition and a name. But should we not be in this position the
trae value of our investigations is lost to us, and we make an
approach rather to hypotheses than to truth.

Thus Degeneration — ^^ morbid anthropology^^ — ^in all its forms,
whether external or internal, and all such as invade the internal, and
still more those that affect external organs, must form the important
subject-matter of our next discourse — conditions which as yet are
new in the teaching of mental disorders, and on behalf of which I
ask your earnest attention.

These subjects being discussed, we come lastly to the principles
of treatment as laid down in harmony with the latest teachings, and
with the practice of non-restraint ; and it will be for us to consider
whether the insane are to enjoy their freedom with all their pecu-
liarities, and with all the advantages and disadvantages of the
mingling of diseased and healthy individuals. On this question, I
shall have the opportunity of placing before you the results of
personal experience and of prolonged study in the countries already
named, and in numerous asylums throughout Europe. Thus you
will see that the matter lying before us, although it may be theoretical
in character, possesses also a practical value, and it will be my
endeavour so to deal with my subject that when you are called upon
to visit an insane patient, instead of saying with some perturbation,
— ^^ Do not ask me. It is not in my way. Send to the Asylum.'^ —
you will with full confidence, if you have been a profitable learner of
the pathological and of the clinical portion of my teaching as based
upon that theory which I maintain, be enabled courageously to say,
when called to such a case, ^^ I will attend to it at once.^' Then
will the speciality of psychiatry be united in your case with general
practical medicine, and that most admirable goal in science be
attained, namely, *^ universaUty.^'

Let me in conclusion, my friends, thank you for your attendance
here to-day in such numbers and in such earnestness.

176 [July,

CLINICAL CASES.

The Non-restraint System in the Treatment of a ^'certain class of Des-
tructive Patients." By S. W. D. Williams, M.D., L.E.C.P.
Lond., Assistant Medical Officer, Comity Asylum, Hayward^s
Heath, Sussex.

In the April number of the 'Journal of Mental Science,' the
editors append a foot-note to a paper by Dr. Edgar Sheppard,* asking
from some members of the Association the results of their expmence
in the treatment of the troublesome class of patients referred to in
that paper, and at the same time recording their dissent from the
opinions expressed by the author. Moreover, at the end of his paper
Dr. Sheppard writes : —

''The Commissioners in Lunacy, asked by me in full conclave to
give some suggestions as to their views of treatment under these
perplexing difficulties, advise me to consult my professional brethren,
and are content to put on record their disapproval of my views. In
this, the literary organ of our Association, therefore, I invite the
dispassionate consideration of a subject about which I hav€ been
candid and outspoken, and of a treatment which recommends itsdf
to me as above all things humane.^'

As yet no answer has been given to these appeab. This is much
to be regretted, as it might be inferred that the psychobgical
branch of our profession endorses by its silence the views pro^
pounded in that paper. This I happen to know is anything but so —
as the editors of this Journal have received many communications
condemnatory of the treatment Dr. Sheppard advocates, and indeed
I may add of the whole tone of his paper. I have therefore' ob-
tained permission of Dr. Eobertson to publish the mode of treat-
ment adopted towards such cases in the Asylum at Hay ward's Heath,
although I cannot but feel that the subject would have been much
better handled by one of our experienced medical superintendents.
Moreover, it is with considerable diffidence that I advance an opinion
at all in opposition to one propounded by a physician holding such
a position, and so experienced as the author of the above-named
paper. As, however. Dr. Sheppard courts a "dispassionate con-

. * " On the Treatment of a certain class of Destructive Patients." By Edgar
Sheppard, M.D., Medical Superintendent of the Male Department of Colney
Hatch Asylum. — ' Journal of Mental Science/ April, 1867.

1867.] Clinical Cases. 177

sideration'' of the subject so openly, and as he truly adds, has been
80 " candid and outspoken " in writing respecting it, I am sure he
will be the last to object to candour and plain speaking in another.

No one engaged in the treatment of the insane will easily foi^et
the shock he experienced in reading Mr. Pownall's accusations, at the
last Epiphany Middlesex Sessions, against Dr. Sheppard^s manage-
ment ; accusations caught up and distorted by the daily press in so
unwarrantable a manned, that never since the exposure at Bethlem
Hospital in 1852 has the non-restraint system been so dragged
through the mire as it was on that occasion. If Dr. Sheppard had
contented himself with impugning the accuracy of Mr. Pownall's
accusations by a statement of his own story, this unfortunate matter
might probably have rested there ; but on the contrary, he writes a
paper justifying and advocating in very strong terms the mode of
treatment he pursued, and holds up as a pattern to be followed the
lamentable want of judgment and skill which would reduce the
great principle of non-restraint to four bare walls and a wooden floor,
although, as he owns, the Commissioners in Lunacy had already told
him " that for patients to be in rooms without bedding or clothing
is unheard of in this philanthropic age, and that such circumstances
admit of no sort of justification.'^

It would indeed have been inexcusable to have allowed Dr.
Sheppard thus to have offered himself unchallenged as the exponent
before our continental brethren of the practice of the English non-
restraint system ; and although I do not presume to appear as an
authorised exponent of this system, I am nevertheless encouraged to
comply with the request of the editors of this Journal and to record
here the experience I have learnt in the treatment of the destructive
cases in question occurring alike in all large County Asylums. Im-
primis, however, it would appear necessary to consider some of the
arguments Dr. Sheppard advances in support of his theory.

The class of patients then which appear to have baffled Dr.
Sheppard's energies and to have led him to substitute for treatment
" their confinement by night in a nude state, the bedding and cloth-
ing alike withdrawn/' were those suffering from the destructive mania
accompanying general paralysis; and in his annual report to the
Visiting Justices he thus describes them : —

" I have already explained to you (the Visiting Justices of the
Asylum) by word of mouth, that the patients in whom the destruc-
tive propensity usually manifests itself are, for the most part, of the
class termed general paralytics; that their physical sensations and
perceptions are impaired or annihilated ; that they besmear them-
selves with their own filth ; that their skins are of an unnaturally
high temperature; that their delusions are of the grand and ex*

178 Clinical Cases, [July,

travagant kind; that they will stand or sit the whole of the night
naked, with thrir bedding and clothes heaped in one comer of the
room, singing, laughing, gesticulating, and giving every evidence of
their own happiness/' In defence of his position he continues : —
^'It is easy to shut up a destructive lunatic at night and satisfy
the requirements of the public by giving him ordinary bedding and
clothing. But what advantageth it (he truly asks) if he is left un-
noticed till the morning, when he destroyed everything in the first
hour of the night ? Or how much the better is he if visited and re-
supplied merely for the same process to be renewed ?''

Had Dr. Sheppard substituted " a warm or temperate atmosphere,
unseen, but yet appreciated,'^ he might perhaps have correctly pro-
claimed his as relatively the true philanthropy. Yet we have means
of cure as much beyond Dr. Sheppard's theories as they surpass in
science and skill his rough primitive practice. Asked for suggestions
how to treat this form of insanity, I proclaim that my experience
differs entirely from that of Dr. Sheppard when he writes ^^ Medical
treatment — digitalis, opium, the wet sheet — ^will not touch this
malady.'' I say digitalis, opium, morphia, the wet sheet, prolonged
hot and cold baths, the mustard pack, hydrocyanic acid, do touch
with their soothing powers the malady ; careful watching by night
as well as by day will prevent as effectually that marvellous destoiction
of property which Dr. Sheppard mourns over, as the withdrawal of
the bedding and clothing. Judicious attention to dietetics and care-
fully regulated exercise will induce sleep as effectually as '^ the gentle
influences" of a "warm or temperate atmosphere," and such I
believe will be reduced to demonstration in the cases I am about to
record in this paper.

Dr. Sheppard further defends his method of treatment by another
startling statement. " It must," he says, ^' be known to any com-
missioner who has been a superintendent of an asylum of any
magnitude, that numberless j^atienU are uncovered the whole night;
that they will stand up naked or lie upon the bare floor, having
heaped their bedding and clothing into one comer of the room or
amused themselves by tearing it to pieces." Surely this is a most
gratuitous assertion. We must presume it is true of Colney Hatch,
but is it true of any provincial County Asylums? In a leading
article in the ' Daily Telegraph ' the following sentence appears : —
" If such horrors can occur at Colney Hatch under the rule of a
gentleman whose character, both for skill and humanity, is excellent,
who can say what still grosser infamies may not be perpetrated in
asylums less conspicuous?" It would be interesting to know
whether the writer had ever been in a position to compare Colney
Hatch with our provincial Asylums.

I have now lived for seven years as medical oflBcer in three large
County Asylums, and had pass through my hands at least 2000

1867.] Clinical Cases. 179

insane patients^ but I emphatically deny any knowledge whatever of
such a state of neglected misery. It has never in either of these
asylums been the practice of the medical superintendent to sanction
the existence of such a state of things. I have read of it in Dr.
Conolly's eloquent denunciations of the old abuses at Bethlera and
at Hanwell, but I have never learnt the necessity of such practice
from those under whom I have studied this branch of my profession.
The commissioners might well, as Dr. Sheppard naively tells us they
did, be content to put upon record their disapproval of his views.

Furthermore, Dr. Sheppard has brought forward an ingenious
physiological theory in justification of his plan of treatment; unfor-
tunately his physiology when weighed in the balance appears to be
as faulty as his treatment. As already stated, the class of patients
under consideration were those suflFering from the destructive mania
of general p^lysis. He states that there are two classes of de-
structive patients. In one there is, according to his view, a
state of dermal anaesthesia, diminished, almost annihilated sen-
sibility, little or no elevation of temperature. In the other
class there is heightened sensibility, dermal hjTpersesthesia, with
great elevation of temperature. In these cases (he adds) the
skin, continuously exposed in a room of ordinary or even of low
temperature, retains its elevation. Now, argues Dr. Sheppard,
wherever there is a hot hypcrsesthetic skin, clothing of any kind is
a distressing burden, and self-created nudity is the result, as being
alone supportable ; er^o, let a patient so suffering follow his bent ; it
would be cruel and iiJiuman to attempt by treatment to remove the
cause of the evil or to break him of his bad habits ; turn him nude
into a room (it is true " lined with kamptulicon, linoleum, or india-
rubber, or some other durable yet yielding substance," and " heated,
when necessary, by a common apparatus, to a temperature varying
with the season of the year'*), devoid of all furniture or bedding,
there to wander aimlessly about, left to contract what habits of
filthiness he may choose, and to sleep, if he can, through the long
hours of the night till morning, uncaring and uncared for.

It would thus seem that Dr. Sheppard places his plan of treat-
ment entirely on this alleged dermal hypersesthesia — this supposed
great elevation of temperature. When Dr. Sheppard writes thus
is it merely a theory he advances, or is it due to facts proved by
experiments ? If the latter, it is to be regretted that he should not
more fully have recorded his observations on the continuous height-
ened temperature of skin in the patients whom he submitted to the
method of treatment he would thus defend. During the last twelve
months I have paid great attention to the use of the thermometer in
insanity, and have carefully observed and recorded the variations of
temperature occurring in all classes of mental disease, and the conclu-
sions I have arrived at are so entirely at variance with Dr. Sheppard's

180 Clinical Quei. [J^Ji

theory^ that it was this difference in our experience which first
led me to the idea of writing this paper, believing that could I but
prove Dr. Sheppard's scientific deductions based on error, even
setting aside all philanthropic considerations, the condemnation of his
plan of treatment must perforce follow. Shortly, then, the result of
mj observations causes me most decidedly to doubt that in cases of
general paralysis, however violent be the accompanying symptoms of
destructive mania, there is dermal hypersesthesia, or great elevation of
temperature; on the contrary, I beUeve that in such cases the
normal temperature of the body is uniformly, and at times even con-
siderably reduced. There is only one condition of insanity in which
we get an increase in temperature, and that is in phthisical insanity ;
in such cases the thermometer will at times mount up as high as
105°, in no other have I ever found anything but a reduction, not
even in the most violent acute sthenic mania. So 9nrely as the
mind is diseased, so surely, unless the insanity is due to phthisis,
will the temperature be reduced below the normal standard, and the
lower the type of the disease the more marked is the departure from
the average — so true is it that insanity is essentially a disease of
debility.

Before I had any intention of writing this paper, or indeed knew
of there being any occasion for it, I had compiled the following
table for an article I was preparing on ^'The Use of the Ther-
mometer in Insanity.'* It may be interesting to give it here. I
took four as typical cases of the various forms of insanity as I could
pick out in the Hayward's Heath Asylum, and endeavoured to
obtain the normal temperature of each case under as nearly as pos-
sible the same existing circumstances, using a thermometer made
by Casella, and verified by Dr. Aitken, placing it in the axilla, and
allowing it to remain there six minutes in each case.

I may premise that I take the normal temperature of the human
body to be 98°-4, that being the degree settled by Dr. Aitken. The
results of my observations were that in

4 cases of acute mania the highest temperature was 98^ the lowest 96°

4 „ chronic mania „ 97° o«o./.

4 y, melancholia „ 97°*4

4 „ dementia „ 96°'4

4 „ melancholia Attonita ,, 96°
Genend paralysis —

2 cases of 1st stage „ 98°

3 „ 2nd stage ,. 98°

4 „ 3rd stage „ 96°-4
EpUeptic mania „ 98°'6
Phthisical mania „ 105°

It will also be found that in the cases appended to this paper the
temperatures of the destructive patients is from time to time
recorded, but in none is there any elevation. Such being the case.

96°

»}

94°-6

95°-6

9r-2

96°-4

»>

95°

96°

99P

1867.] ainical Cases. 181

I cannot but think thsKt Dr. Sheppard's theory falls to the ground,
and that we must look to the cause of the symptoms so graphically
described by him not at the periphery, but in the nerve centres.
Towards th^e, then, should our plan of treatment be directed.

I have careftdly selected the worst forms of destructive mania
which have occurred in the practice of the Sussex Lunatic Asylum,
ance 1 have been attached to it* I venture to think that the
simple record of the treatment pursued to mitigate these distressing
symptoms, wiH do more to sustain the credit of the non-restraint
system, than any further attempt on my part to discuss the startling
theories and inaccurate observations in Dr. Sheppard's recent
paper.

E. C, female, 8Bt. 34. — Recurrent Mania, — Admitted 5th February, 1866.
There is nothing exceptional about this patient beyond the fact that, as she
hss frequent attacks of recurrent excitement, during which she is noisy,
violent, and destructive, and has a strong tendency to remove all her clothing,
whilst in the intervals of her attacks she appears quite rational and sane and
in fair bodilj health, she seemed to me a good case to determine whether
there was any rise in temperature during the periods of recurrent mania.

I therefore took the temperature and the number of beats of the pulse
daring a sane and an insane interval every morning at 10 and every evening
St 7, and the following is the result of my observations :— -

Oct. 1st. — Temp. 9S°; pulse 70. Quiet and rational, so she remained until

80Ui. — Temp. 97°; pulse 60. Suddenly relapsed; has been noisy and
emotional all the morning.

3Ist — ^Temp. 97°'4 ; pulse 70. Quiet all night and more calm, but still
a little strange.

Nov. Ist. — Temp. 97°'8 ; pulse 64. Much as yesterday.

2nd. — ^Temp. 97*3; pulse 62. Still strange, but quiet.

3rd. — Temp. 96° ; pulse 78. Noisy and destructive ; incoherent.

5th. — Temp. 95°' 8 ; pulse 64. Very excited ; no sleep last night.

6th.— Temp. 97°'2 ; pulse 60, feeble. Excited at times.

7th. — ^Temp. 97°-2 ; pulse 68. Quiet, but emotional.

8th. — Temp. 95°-3 ; pulse 64. Incoherent ; menstruating.

9th.— Temp. 97°*2 ; pulse 68. Calm, but slightly hysterical.

10th. — Temp. 95°*2 ; pulse 68. Very wild ; destroys her bedclothes.

11th. — Temp. 96°'6 ; pulse 66. Looks feverish and flushed.

32th. — Temp. 96°; pulse 68. Much as yesterday.

13th. — Temp. 96°-2 ; pulse 56. Quiet but very languid.

14th. — Temp. 97°; pulse 60. Better in every respect.

17th. — ^Temp. 95°* 2 ; pulse 60. Relapsed again ; in the night was very
noisy and destructive and had no sleep.

18th. — Temp. 97° ; pulse 64. Quieter again.

19th. — Temp. 97°'4 ; pulse 68. A little changeable, but much less emo-
tional and excitable.

20th.— Temp. 97°'2 ; pulse 68. Calm and rational.

E. B. F. — , set. 40. — Admitted 2nd July, 1 866. — Previously to her admission
into Hayward's Heath Asylum, had been in Bethlem Hospital for eighteen
monihs, and daring the whole period of her confinement there she had been
in a state of the most furious mania, and so violent that it always required
five nurses to dress or undress her or feed her. Her removal from Bethlem

182 Clinical Cases. [Julj^

to Hajward's Heath was marked by one continual struggle, and men bad to
be hired on the road to assist in restraining her.

On her admission into the asylum at Hayward's Heath, she is stated in the
case book to be '* in a state of tne most violent irrational mania, more closely
resembling the cases we read of in old text-books than the insanity of these
latter days. She is never quiet for one nngle moment, but is continually
raving, shouting, gesticulating, biting, kicking, blaspheming, and destroying ;
and appears quite incapable of understanding anything that is said to her/'
Her physical condition also was bad ; she was thin, weak, and feeble, and
covered with bruises and small sores; her pulse was small, thready, and very
frequent ; her skin was dry and yellow, and emitted a sour smell ; the lips
were dry and parched ; and the temperature as nearly as could be ascertained
was scarcely 96*^.

Here was one of the most trying cases 1 have ever witnessed, and for
nearly a month she gave us more or less trouble and anxiety. She tore up
her clothes ; she was noisy and restless to a degree ; refused all food ; and it
required such an unpleasant scene of struggling every time it was necessary
to do anything with her, and it was so utterly impossible to ^ive her any
medicine, that Dr. Robertson, as a last resort, administered cnloroform one
day to her, and, whilst she was partially under its influence, gave her nearly
a pint of essence of beef tea and one erain of morphia, after which she slept
for some time. This was on the ninth day after her admission, and I should
record that previously she had several times been packed in the wet sheets,
and had douches and warm baths, with but little benefit. Subsequently she
was placed under the influence of a mixture of ether and chloroform three
or four times a day, and a^ain of morphia was given her each time. Under
this treatment she slowly improved ; first beginning to sleep better and to
tear up less clothes, then to take her ifood without trouble ; and when we had
arrived at this point the inhalation of the chloroform was omitted by degrees
and 58S of Tinct. of Digitalis inserted into her beer three times a day. She
continued under this treatment for some weeks ; at first with varying benefit,
although she never quite relapsed into her former dreadful condition.
Within three months, however, of her admission she had become much better,
had lost all excitement and violence, fed, dressed and undressed herself, and
employed herself with fancy work, at which she is very skilful. Her mind
appears, however, to have received, during the many months of her illness,
too severe ii shock ever completely to recover itself; and, although she is
now in the enjoyment of extremely good physical health, her insanity has
assumed a chronic form from which but little more can be hoped.

M. M — , female, set. 38 years, married. — General Paralysis. — Wife of a
beershop keeper, assisted her husband in the business, and was a good
worker in the shop, but always of a passionate disposition ; has had six
children ; is said to have been of very intemperate habits lately. She is
described in the case book on admission as having the appearance of a person
labouring under delirium tremens, but the sequel of her case shows that it
was in reality the mania of general paralysis. As she was reported on
admission not to have slept for ten nights, and, although still very excited,
was much exhausted, Liq. Morph. Acet. 5ss in one ounce of brandy was
ordered every four hours. She did not sleep however, although this treat-
ment was pushed for twenty-four hours. The next night one dose of Tinct.
Digitalis 5'] was given, and she slept for nine hours, and awoke much calmer.
This was continued with good results for some nights.

January 4th. — Not so well; menstruating much; pulse feeble. Omit
Digitalis. To have a cold hip-bath for ten minutes, one pint of porter, two
glasses of brandy, four eggs daily, and small doses of ether and opium.

1867.] ainkal Cases, 183

January 2(Hh. — Better physically, but noisy and destructive, symptoms of
eeneral paralysis coming on-^monomanie des grandeurs — hesitation in speech,
halting gait, &c. Tinct. Digitalis, 11^ ^x, ter die.

After a month or so there was a marked amelioration in her condition and
she became quite calm and very industrious, but retained her delusions of
wealth, &c. On the 23rd of September following, however, she relapsed
niddenly into a state of furious mania, and would toferate nothing on her ;
was packed in the wet sheets, and the Digitalis, which had been omitted,
returned to. This treatment was pursued for some days, and with beneBt ;
bat on her relapsing again it appeared to have lost its effect, and she gave
08 much trouble and anxiety for many hours, nothing apparently quieting
her excitement. She was finally placed in a warm bath and retamed there
for upwards of an hour. This had the desired effect and she became calm.
It was several times repeated, always with a good result, and she gradually
became demented, and passed quietly through the various phases of her mortal
disease to her death.

F. C — , male, set. 47. — Dipsomania. — Admitted 6th February, 1867. Was
apprehended for indecently exposing himself in the streets of Brighton and
taken before the police magistrate, who sent him here. He had just had a
Sam of money paid him, and had been drinking heavily for the last three
days without eating much. On admission he is described as being in a state
of most violent excitement, noisy, violent, and restless to a degree, quite
irrational, and perfectly incapable of using his reasoning faculties to any
right purpose. He was brought to the Asylum confined in a strait waist-
coat, and held down in a van bj four men, and appeared in a very low state
of bodily health.

I now quote from the case-book : —

April 7th. — Ue was so violent on admission, and so obstinately bent on
going about in a state of nature, that it was necessary to pack him in the wet
sheets at once. On being taken out the second time he was perfectly calm
and rational. He took a little beef tea and brandy, ^ij, was put to bed and
slept for several hours. Temp. 97°.

8th. — When visited by the attendant this morning he was standing up in
his room quite naked, and all his things torn up. Immediately the attendant
opened the door, he made a most savage attack on him, and continued so
violent and excited that he was again ordered into the pack, and was kept in
for ten hours, being taken out every hour and a half and a little whisky or
brandy given.

He soon became calm, has progressed uninterruptedly towards recovery
ever since, and ere these pages 6nd a reader will be again working at home
for his family. He never had a single dose of medicine during the whole
time he was in the Asylum.

E. P — , male, set. 49. — General Paralysis. — Was admitted into the asylum
at Hayward's Heath, on 23rd May, 1865, in a state of mania, with a threaten*
ing of general paralysis indicated by the delire ambitieux and the ** modifica-
tion of articulation,*' which Dr. Bucknill truly terms that slight but fatal
shibboleth of incurable disease, which is *' neither stammering nor hesitation
of speech,*' but a modification of both. During the first few months after
admission he improved considerably, and at one time his discharge was can-
vassed, nothing remaining of his disease but the hesitation in speech. So he
remuned for nearly twelve months ; but the verdict had gone forth, and
graduaUj his dreadful disease returned with all its vigour, and he became
Tery demeoied, of dirty habits, and most destructive.

On Uie I2th A^ril, 1867^ the entry in the case-book is as follows : — '* Has

184 Clinical Gases. [July,

been Tery noisy and destructive for the last ti^o nights, atid will noi remain
in bed, wandering about the room quite naked. Temp. 95*6^. JpL Liq.
Opii, Tinct. Digitalis aa 11^ zr every four hours. — 14th. Has sl^t quietly
for the last two nights, and is better to-day." Verily Dr. Robertson Was
right when he stated Digitalis to be almost specific in its acUbn in general
paralysis. This poor man still lingers on in the last throes of hta deadly
disease ; but, as long a) digitalis is judiciously administered to him, he will
drift slowly but calmly to his determined end, without trouble either to
himself or his neighbours.

B. H — , male, set. 34. — General P<ir<i/ym.— Admitted 17th May, 1867.
Insanity in the family. He fell off a ladder whilst em|^oyed on hn work as
a plasterer about three years ago and injured his spine. He has never been
able to return to his work since, and for some time ha^ been in the Union
Workhouse, but has latterly become so noisy and so destructive that his
removal to an asylum was absolutely necessary.

On admission he was in a state of mania, very restless and destructive,
constantly crawling about and pulling to pieces everything that he could lay
his hands on, and never contented unless undressing himself; very dirty in
his habits, and incapable of controlling himself in any way. If conversed
with, he would give coherent answers for a minute or two, but soon became
lost and confused, and although clearly remembering his accident and every-
thing preceding it, he had but little memory for recent events, and, clearly,
answered at random. The physical symptoms were marked by very decided
want of co-ordination in muscular action ; when about to speak the lipd
became extremely tremulous, and the tongue was protruded with indecision ;
when he attempted to walk, it was with difficulty he could stand even, and
only with sreat effort he could struggle on a few paces ; moreover, he had
but partial power over the action of the sphincters ; yet, withal, he was
plump-looking and well nourished, and his limbs showed considerable
muscular development, although the countenance displayed the round contour
of feature and want of decision so frequent in general paralysis. There
was also a decided want of excito-motory sensibility in the muscles, particu-
larly of the lower extremities. The pulse was 70, full and firm ; but although
he appeared in such good general health, the thermometer in the axilla never
read higher than 96*6% although left in ntu for more than ten minutes, and
recorded at all hours of the day.

On the first night of his admission he was placed in an ordinary bed in a
single room. He never slept at all, but employed himself all night in tearing
up nis clothes and crawling naked about the room ; he was also both wet and
dirty. The next day his diet was specially regulated so as to be highly
nutritious but at the same time totally freej^om stimulants^ a very important
point in general paralysis. For experience at Hayward*s Heath has taught
us that, whilst in acute mania you cannot well administer too much stimu-
lant, in general paralysis, on the contrary, nothing is so hurtful, nothing so
liable to give rise to noise, violence, and destructive habits. As evening
approached he had 58s of Tinct. of Digitalis and V\ xx were repeated every
four hours through the night, and, although he did not sleep much, he lay
calmljr in bed and gave the night attendant no trouble. So he has remained
ever since, and although his disease is making rapid strides, and he is becom-
ing daily more helpless and insane, the calming effect of the digitalis is such
that since the first night he has not destroyed a single article.

H. F — y male, set. 34. — Acute Mania passing into a chronic stage, — Admitted
24th October, 1865. Hereditary Insanity. When admitted he was ex-
tremely wild and excited ; talking in a loud voice, gesticulating ireely, and

1867.] Clinical Cases. 185

using obscene lansniage. Had various delusions ; offered his doctor three
million pounds ; declared that all his relations were poisoned, but that they
were to be buried in St. Paul's Cathedral bj his orders, &c. He was thin
aad eiptviciated, and looked pale and haggard. Pulse 100, full but easily
oompresaed; tongue very dry, coated, and cracked; heart's action weak
Mid laboured; slight consolidation at apex of ri^ht lune ; small hydrocele.

For fully twelve months he remained mentidly in the same state, noisy,
destructive, iMid dirty, and quite the opprobrium of the asylum. Purgatives,
morphia, warm baths, warm mustard batns, digitalis, packing in the cold sheets
and m the 4»i^tard sheets, all were tried in turn, but with little or ^o benefit,
except that ^ the mania passed from the acute to the chronic stage he
gradaally regained his general health and became quite strong and hearty.
During the whole of tms time it was the sole duty of one attendant to look
after him. At one time V(\^ x doses of dilute hydrocyanic acid were given
him every fifteen ininutes daily until the pulse was affected, but all with no
benefit. Finally, in October last, he was placed on 5J of Liq. Opii every
three hours, and from that moment he began to mend. He has now for the
^t ^ee pionths been fit wprk with the cabinet-maker, and is about to be
discharged recovered. Of a surety this case points out hpw necessary it is to
perqevf^re in treatment, how slow we shpuld be to come to the conclusion
tlMit the patient is incprable until all the means at our command have had 4
£ur trJa|.

W. B — t male, set. 42 years^ married. — Spinal Paralysis j Delusional Mania.
•—Admitted 2nd November, 1865. Was an auctioneer's clerk ; was in the
accident in the Clayton Tunnel ; injured his back ; has never been so fit for
work since, and has a slight but decided paralysis of locomotion in the lower
extremities. On admission he was very incoherent in conversation, answered
questions indeed, but immediately wandered from the subject; full of
delusions ; fancied himself Christ ; stated that he and his family were going
up to London to visit the Queen, that he is possessed of great wealth, &c.
Body in fair condition ; pulse 98, weak, fluttering ; tongue covered with a
white fur and tremulous. Has a mark on the lower part of the back, appa-
rently caused by an abscess, as well as marks of having been cupped on the
nape of the neck. He was very restless and excited. There were many
symptoms in this case tempting one to diagnose general paralysis — such as the
pecmiarity of gait, the tremulous tongue, the monomanie des grandeurs — but
this hypothesis was negatived on closer examination, and thus : the peculiarity
of gait was not the quick shuffling motion of the general paralytic, who
seems to be helping his progression with all the muscles in his body, but was
caused by his walking in a straggling and flat-footed manner, with high
action, and as if his foot did not belong to him, which Dr. Bucknill tells us
is a sure symptom of spinal paralysis ; moreover, the tremulous tongue was
unaccompanied by any modification of articulation, and I take it the two are
never uncombined in general paralysis.

Became much worse after admission^ and had frequent recurrent attacks
of violent excitement, and was full of the most extravagant illusions; thus,
to quote from the note-book :

December 7th. — Very excited ; says the water-tanks are poisoned ; passed
a very restless night, stripping himself naked. To have 5^^ doses of the
Mist. Sed.* and half a glass of sherry every two hours until calm.

♦ ^ Morph. Acet., gr. i;
Tot. Capsici, nv;
Acid H^drocyan' dil., nv;
^her Chlpr., nxlv ;
^treacle guttse, v.

* 51 Sedative mixtfire.

186 Clinical Cases. [July>

10th. — Still a tendency to noise and violence, but is easily pacified, llie
sedative has a good effect. Continue ^ss ter in die.

August 24th. — Has been very excited for some days, and last night he
became extremely noisy, destructive, and excited. He had secreted a piece
of tobacco-pipe, and when visited b^ the night attendant, had scratched his
left arm and neck very much with it, and had torn up all his clothes. This
morning he is in a state of acute mania and full of strange illusions — that he
is Christ, that his urine is full of diamonds, his foeces are gold, &c. Is to be
packed in the wet sheets and chaniifed ever^ hour and a half all day, and to
have TTV ^lx each of Liq. Opii and Tinct. Digitalis every three hours.

25th. — Became calm towards last evening, and passed a quiet night.

1867. January 16th. — ^Very deluded and excitable just at present. Believes
himself to be the Saviour ; that he can pardon sins, &c. ]^ Tinct. Digitalis,
Liq. Opii, aa TTI xx ter die S.

27th. — The digitalis stopped for two days ; sedative instead, 5j« every four
hours. All the old svmptoms returned — tearing his bedding, noisy, inco-
herent. Sometimes wnen under the digitalis he is apparently well, admitting
his delusions for a short time, but always calm ana pleasant. Kenew the
Digitalis TH. xx c. Liq. Opii, TH. xx.

28th. — Is better this morning and more collected. — Since the above date
he has been kept under the influence of the digitalis, and from being noisy,
destructive, and dirty — a torment to all around him, both sane and insane —
he has become quite a pleasant patient, although as deluded as ever, and as
little likely as ever to become fit to leave an asylum. That this change is due
to the influence of the digitalis none who have watched the case can have a
shadow of a doubt.

E. K — , female, set. 30 years. — General Paralysis. — Admitted 29th Decem-
ber, 1866. Had been married for some years, and was in easy circumstances,
but had never borne children. Always predisposed to melancholy and
depression of spirits, which had been lately much exaggerated by constant
physical debility. Mentally, on admission, she appeared to be in a state of
acute dementia, had apparently but little memory, and but very limited
volitional power, whilst her intellectual faculties were much paralysed, and
she had considerable difficulty in collecting her ideas sufficiently to answer a
question. Her speech was very hesitating and drawling, and she could
scarcely pronounce certain words. She was noisy at times, fond of undress-
ing herself and picking her clothes to pieces, but good-humoured and happy,
and declared herself to be " quite well ;** which was however belied by her
pale, thin, and debilitated appearance, her liesitating gait, and the marked
want of consentaneity in all her muscular actions. Her pulse was feeble
and at times rapid ; the pupils irregular, right dilated, left contracted. But
the most peculiar feature in her case was the presence of tubercle in the lung
and large cavities, the only time I can ever remember seeing phthisis and
general paralysis conjoined,. This, however, accounted for the high tempera-
ture, which was firequently over 100°.

January 2nd. — Restless and noisy, especially at night, will not remain in
bed. Ordered nourishing diet. $> Liq. Morph. A. Tinct. Digitalis aa
Xtl XV ter die.

6th. — Quieter, but very lost and helpless ; breath very offensive ; tongue
white and coated. 9> Hyd. c. crets. ^r. v.

7th. — Had a good night and remained in bed. Temp. 99°'2.

24th. — Remams decidedly better, but is still at times restless and fretful.
Continue the medicine in smaller doses.

26th. — ^Very noisy the greater part of last night, but became calm after a
warm bath and an extra dose of medicine. Temp. 100°. Thb was her last

1867.] ainical Cases. 187

outbreak of excitement ; she rapidly became more demented, and her health
failing still more rapidly, she soon succumbed to her various ailments.

H. H — , male, set. 46 years. — Epileptie Mania. — Admitted 24th January,
1861. Has been subject to attacks of epilepsy for the last fifteen years.
They recur every six weeks or two months, and are supposed to have been
origmated by exposure to choke-damp when engaged at work in a railway
tunnel. The attacks have lately gradually become more severe, and are
accompanied by paroxysms of great violence and excitement, and when
admitted he was ni a state of the most extravagant excitement, and most
dangerous to every person and thing around him, although quite incoherent
and apparently unconscious of his actions. For about twelve months he
remained the bete noire of the establishment. His fits would recur every
month or so, and for about a week he would be perfectly unmanageable, and
often require three or four strong men to be with him as no ordinary single
room could contain him, so great was his strength and so violent were his
efforts. Various plans of treatment were adopted and carried out, such as
regular packing in the wet sheets, &c., but all to no purpose, and he seemed
to be getting worse. About this time, however, Dr. Kobertson was reintro-
ducing the use of digitalis in mania, and H — was put on large doses. Since
then he has gradually lost all his former violence and excitement, and although
the fits of epilepsy were nearly as frequent as formerly, nevertheless, they
were never again accompanied by the former excitement, so long as the
digitalis was regularly given. His general health seemed to be very good,
and he worked on the farm in the summer and in the tailor's shop in the
winter up to a few months ago, when he died somewhat suddenly in an
epileptic fit.

I trust this brief record of a few cases, selected as the most un-
favorable we have had during my tenure of office here, will at least
show Dr. Sheppard how greatly the experience and practice of this
asylum differ from that pursued at Colney Hatch. It is not for me
to determine which of the two more faithfully interprets the great
principles of the non-restraint system on which the practice of both
these asylums alike professes to be founded. Yet I trust that other
observers may add the results of their experience in vindication of
the humane treatment of the insane in the English County Asylums
— a treatment so gravely, I must say, aspersed by Dr. Sheppard's
ffl-judged paper.

188 [July,

PART II.— REVIEWS.

Idiocy and its Treatment by the Physiological Method. By Edwaed
Sequin, M.D. New York : William Wood and Co., 1866.
Pp. 459.

The subject of which this volume treats has of late years com-
manded so much attention, and the efforts which have been madef<»r
its ameUoration have been so earnestly supported, that any treatise
thereon would necessarily command attention. THie fact, however,
that this book is by one who in the infancy of the work devoted to
it much time and labour, and furnished at that period the best
treatise on the subject gives to these pages more than ordinary im-
portance.

With vivid recollections of the French writings we opened with
much interest the volume before us, feeling assured that whatever
might be its faults it would bear the impress of the earnestness of a
writer, who had manifested in former years great love for his work,
and that it might possibly be enriched by the matured experiences
of one who in the mean time had had the advantage of a superadded
medical culture.

The object of the book as stated in the preface, is to embody,
^' 1st, our present knowledge on Idiocy ; 2nd, the method of treatii^
idiots ; 3rd, the practice of the same ; and 4th, an outline of the
direction to be given to the scientific efforts of the friends of idiots,
and of the apostles of universal education.'^

The work opens with an introduction of twenty-seven pages,
which gives an epitome of the efforts which have been made for the
benefit of idiots throughout the world, and traces their ongiii to
the philosophical labours of Itard to educate the savage of the
Aveyron. Itard did not believe this savage to be an idiot, or he
would not have undertaken his education ; for he believed idiocy to
be incurable. His object was '^ to solve the metaphysical problem of
determining what might be the degree of intelligence, and the nature
of the ideas in a lad, who, deprived from birth of all education,
should have lived entirely separated from the individuals of his kind.''
Itard was unsuccessful, and finding that his savage was also an
idiot, gave him up to terminate his existence in the wards of the
Bic^tre. While acknowledging the value of the physiological method
which Itard evolved, we cannot help feeling that the author has
been carried away by a flood of enthusiasm when he attempts to

1867.] Reviews. 189

prove that all the improvements in general education owe their origin
to the efforts put forward to educate idiots and deaf mutes.

To agree with our author would be to elevate idiocy into a source
of incalculable good, to believe that but for the blighted mind of the
idiot, modem civilization would have languished in the thick mists
of unenh'ghtened pedagogy. Our own opinion is, that the change
which has taken place in education has been a natural development
of the hand in hand progress of mental philosophy with physiology^
and that the education of idiots has shared with that of healthy
minds in the advantages of the happy combination.

It is scarcely doing justice to Jean Jacques Eousseau to imagine
that he was indebted to Pereire for all his theories on physiological
teaching. It often happens that similarly constituted minds are
simultaneously occupied with the evolution of the same ideas. The
onward march of events appears to give the stimulus, and the outcome
is often the expression of the same determining influence. Nor do
we think that justice has been done to Pestalozzi, when he is charged
with deriving all that is good in his system from Eousseau and all
that is defective from himself. He at all events has the merit of
having popularised the principles he enunciated and of having re-
duced them to a practical shape.

The synchronous origin of ideas cannot be better illustrated than
by the snowing of the author, that Guggenbuhl and Saegert opened
their schools simultaneously in Switzerland and at Berlin without
any knowledge of Seguin's writings or practice in Paris.

Passing from the historical introduction, the first part is devoted
to a return^ of ^'our present knowledge of idiocy.'^ Every author
probably has his own definition of idiocy. Dr. Seguin, in putting
forward his, wisely avoids laying much stress on it. He says " idiocy
is a specific infirmity of the craniospinal axis, produced by deficiency
of nutrition in utero and in neo-nati.'' The producing causes of
idiocy are classified as '^ endemic, hereditary, parental, or accidental/'

** Idiocy is endemic only as connected with some forms of cretinism. It is
eonsidered hereditary where there have been cases of idiocy or of insanity in
the preceding or collateral generations. It is called parental when referred
to certain conditions of the father or mother. The direct influence of the
former ceases after conception, the intimacy of the latter with her fruit is
incessant during the eventful periods of gestation and lactation ; hence the
thire of the mother in circumstances favouring the production of idiocy is
the larger. She may have been underfed in poverty herself, or through
inrevious generations ; or so miserably enervated by music, perfume, savours,
pictures, books, theatres, associations, that a precocious loveliness has out-
grown her motherly capabilities ; as forcing converts the pistil and stamens
of flowers into beautiful, fruitless petals.

. ''She, being pre^ant, has used for exclusive food unnutritious substances,
•och as pekles, dainties, lemons, tea, brandies, &c. ; or vomited all real food
loon afler ingestion. She has conceived at a time when spermatozoa have
cneoontered noxious fluids of either venereal or menstrual origin, or have

VOL. xin. I'l

190 Reviews. [July,

been altered in their vitality previous to their emission by drunkenness, &c.
She is often passive under the causes of impressions, depressions, shocks,
privations, exertions, abuses, excesses, altering the nutrition of the unborn
or new-bom child.

" But all these circumstances do not seem to act with the same enei^ or
frequency in the production of idiocy, which is attributed most of the time,
by women worthy of being trusted, to sudden or protracted impressions of
an accidental or moral nature. The same tendency appears to extend the
power of these circumstances through the period of lactation, in which
mothers, morally affected, have seen symptoms precursor of idiocy, such as
convulsions, follow immediately the ingestion of milk, and idiocy, paralysis,
epilepsy, or death supervene.

'* Accidental idiocy afler birth, by innutritions diet and want of insolation,
and of other hygienic requisites ; by hydrocephalus, measles, hooping-cou^h,
intermittent fever, &c. In the above circumstances, as far as we hav6
learned, must we look for the origin of idiocy and its annexes."

Thus in a few paragraphs Dr. Segoin dismisses the subject of the
cause of idiocy. We cannot allow that it fully represents what is
known on the subject. It is not a little remarkable that he omits
altogether the influence of marriages of consanguinity^ and disregards
those slow but effective degradations of race which those who have
paid much attention to the subject have recognised. Our own obser-
vations have impressed us with the importance of the influence of
the tubercular and strumous diatheses on the part of the progenitors,
and have not led us to attach the same value as our author to
" music, perfumes, savours, pictures, pickles, dainties, or lemons.'^
Moreover we think too much stress is laid on the retrospections of
mothers as to transient impressions during pregnancy. Nothing k
more common than the desire of parents to find any accidental cause
for their child's malady rather than the more frequent one of degene-
rative influences in their race.

Dr. Seguin divides idiocy into simple and complicated, and the
simple he subdivides into profound, organic, functional, and sthenic.
The complications he notices are cretinism, epilepsy, chorea, para-
lysis, deafness, and blindness.

We are of opinion that our author attaches too much importance
to chorea as a complication. It is true that among those afilicted
with chorea a certain amount of mental feebleness is engendered,
but among idiots properly so-called, although the co-ordinating
faculty is low, chorea does not occur more frequently than in about
1 per cent, of the cases of idiocy, and then in a chronic form.
Among well-fed idiots we have never known a case of acute chorea
to develop itself. Our own experience is certainly in opposition to
the view, that among idiots there is any great proclivity to chorea;
while on the other hand again differing from our author, we have
found paralysis and contractures to be very common, and serious iin-
pedime'hts to the progressive improvement of idiots.

** Idiocy," says Dr. Seguin, ''is called profound when the ganglia are

1867.] Reviews. 191

altered, and superficial when the peripheral terminus of contractibility and
sensation only deem to be affected. It is called organic when the organs are
sensibly altered, and functional when our imperfect instruments and obser-
vations do not permit us to trace the organic lesion as we do the functional
disorder. It is called sthenic when it gives the child nervous impulses with-
out object ; and asthenic when it leaves him without them, when they are
wanted for some object."

We cannot but regard this as a very doubtful mode of classification,
and we cannot agree with the author on its practical value, any more
than on the truthfulness of its scientific import, which he, however,
does not defend.

The pathology of idiocy in the book is very meagre, and our
author appears to have honest misgivings in this matter. He has,
however, good cause to plead for this defect, and has certainly com-
pensated for his deficiency in this part of the subject, by the intro-
duction of some valuable suggestions in the branch of education of
which he is so great a master.

Evidently the pathology so far as it goes, is in great part pro-
blematical, and the same remark applies to the craniologic^ portion
of the subject, which appears to us not to be the result of rigid
personal observation. Much better is that relating to the physio-
logical portion of the subject. Dr. Seguin says —

^ The functions of organic life are generally below the normal standard.
The respiration is not deep ; the pulse is without resistance ; the appetite is
sometimes quite anormal in its objects, or limited to a few things, rarely
voracious, though it looks so, owing to the unconventional or decidedly
animal modes of eating and drinking of these children.

" The swallowing of the food without being masticated, only rolled up in
saliva, sums up many of these imperfections which are to be attributed in
variable proportions to absence of intelligence, want of action of the will on
the organs of mastication and deglutition, deformity of, and want of relation
between the same. As might be expected imperfect chewing produces on
them, as on other children, unpleasant effects, but no more. Their excretions
cannot be said to present any dissimilarity from those of others which our
senses can discrimmate ; only their sebaceous matters are as different from
oun as ours are from those of the variously coloured races, or from those
emitted in most diseases.

^ The functions of animal life, or of relation are generally affected in
idiogr ; either by perversion, diminution, or suppression." # # #

** Idiocy affects the body in its general habits, as bending forward, throwing
the head backward, moving it in a rotatory manner which seems impossible,
swinging the body to and fro, or in a sort of sideway roll.**

The descriptions which are given of idiocy are often graphic, and
are evidently the result of much patient and long observation.
Idiocy has so many phases, and may be classed in such various ways
in reference to etiology and treatment, as well as to the development
of philosophical views respecting it, that it may perhaps be too much
to expect that the treatise should be exhaustive in these particulars.

The author goes on to describe the various anomalies of move-

192 Beview9. [July^

ment^ touchy taste^ smelly hearings sights and speech^ which idiots
present.

We do not at all agree with the distinction the author draws
between the idiot and the imbecile. The imbecile in our view is one
afflicted from birth with a less grave lesion than that which produces
idiocy; whereas the author assigns to this class those only who have
had an arrest of development during youth, and he appears to give
to these unfortunates but a small portion of the aflfectionate r^ard
which he lavishes on their idiotic brethren.

In the second part of the treatise, Dr. Seguin expounds his
principles of physiological education, and here as before points to
the idiot as the source of educational advance. He says —

**The lessons at the hospitals of the incurables and of BicStre, of the
schools at Boston and Syracuse, have not been given through the idiots in
vain.

" Visitors came in and every one carried away some of the principles or
instruments used there according to the chances of a daily practice. Seeing
this, physicians could no longer write on the diseases of children without
expatiating on moral or functional treatment, nor teachers go back to their
schools without cari'ying with them some of our sensorial gymnastics, imitation
exercises, &c. In all this, truly the idiots were the doctors and the teachers.
They taught as much as could be seen or understood in a visit ; they taught
besides, that idiots are not the repulsive beings that our neglect made them,
and that any land would be blessed where women and men would devote
themselves to the task of elevating these unfortunates. Hence institutions
for their education have sprung up everywhere, and the physiological method
was scattered piecemeal in every educational establishment."

Without being sufficiently enthusiastic to attribute all this flood of
blessing to the education of idiots we are far from wishing to depre-
ciate what has been eflfected primarily for Uem, and secondsiily for the
race. An idiot left uneducated is not only shut out from the enjoy-
ments of this life^ and incapable of taking his part in the world's
work, but he uses up the energy of a sane fife, and nullifies, to some
extent, the existence of a more perfect creation. If he be but edu-
cated so as to minister to his own wants, although we may fail to
establish a regulative judgment, we have at all events done much in
increasing his means of enjoyment, and in liberating a productive
worker from the incessant claims of a barren occupation.

That thus much, and even more than this may be done^ has
been abundantly proved both in this country and elsewhere.

The whole of this chapter contains much that is valuable, curiously
commingled with much that is visionary. Nothing can be better
than the remarks on hygiene and the importance of nutrition^ on
the necessity of the gradational character of the edacation^ of teaching
*^ every day the nearest thing to that which each child knows or can
know /' of alternately stimulating and relaxing the attention^ of
teaching by the cultivation of observation and comparison, and using
with tact sensorial impressions for the purpose of devedoping the

1867.] Reviews. 193

higher facilities of mind. He veiy properly begins with the educa-
tion of the muscular system, livery person who has had practical
experience in the treatment of idiots will recognise what importance
should be attached to means employed to overcome anomalies and
deficiency of motion, and how the nervous centres are increased in
power by the healthy stimulus thus afforded to the nerve periphery.
There is a great deal of truth in Dr. Seguin's remarks on the im-
portance of attaining perfect immobility as the starting-point for
action. He says —

"Muscular activity is a function accompllslied by the contraction and
relaxation of the muscular elements; movement taking its fulcrum in
immobility.

"Therefore, before and simultaneously with^ directing the training towards
the acquisition of some special movement, we must accumulate its greater
energy in view of the concentration of activity into positive immobility
wherefrom all action springs. Immobility is taught in various attitudes, —
standing, sitting, reclining one way or another, on some gymnastic apparatus,
with the rifle, the dumb-bells, the balancing-pole, etc. — ^according to
the obstacles which are to be encountered and the various stages of the
training. ♦ * *

" As immobility is in nature the fulcrum of movement, so in our training
it will precede and close every exercise, and serve as transition and as repose
between the various modes of active trainins.'

Our author then takes in succession the education of the powers
of prehension, locomotion, &c., and describes various plans which
may be seen in operation at Earlswood and similar establishments.
This part of the treatise is written with evident enthusiasm, an
mthusiasm which leads the writer on at a rapid pace. The reader
will be apt to imagine that the mindless creature our author first
presents to us is speedily developed into the most plastic being we
could desire. The author has adopted a narrative style of compo-
sition, in which he frequently says, " We do so-and-so, or ^^ Our
pupil can now do so-and-so,^' as if the results were certain to follow,
or even had invariably followed, the means employed. We cannot
help thinking that disappointment is likely to accrue from this ex
cathedra style, and some reaction ensue against the efforts which
may in many cases be advantageously employed. Thus Dr. Seguin
writes —

** After months of alternate individual and group training, in fatigue, of\;en
b despondency, we see them with joy, not only imitating the physiological
exercises, but carrying their few powers of imitation into the habits of life ;
trying to eat, dress, stand as wc do before them, proffering their services to
weaker children, as we tendered ours to them ; and, finally, doing by the
influence of habit what more gifted children do only under compulsion. We
looked at the rather immovable or ungovernable mass called an idiot with
the faith that where the appearance displayed nothing but ill-organised
niattery there was nothing but ill-circumstanced animus. In answer to that
conviction, when we educated the muscles, contractibility responded to our
bidding with a spark from volition ; we exercised severally the senses, but
in impreaaion «ould not be made on their would-be material nature, without

IW Reviews. [J*ily^

the impression taking its rank among the accumulated idealities ; we were
enlarging the chest, and new voices came out from it, expressing new ideas
and feelings ; we strengthened the hand, and it became the realizer of ideal
creations and labour ; we started imitation as a passive exercise, and it soon
gave rise to all sorts of spontaneous actions ; we caused pain and pleasure to
be felt through the skin and the palate, and the idiot in answer tried to
please by the exhibition of his new moral qualities ; in fact, we could not
touch a fibre of his without receiving back the vibration of his all-souled
instrument."

This^ and a great deal more like it^ expresses the subjective wishes
of the writer rather than the objective realities of fife. We can
imagine a reader carried away by this style of expression looking for^
a ready response to all his plans^ and speedily giving up his effort^s
in disgust, in consequence of the want of correspondence betweerm
the results which he obtains and the ruddy reflex of our author^s brain-..^

The chapter on the moral treatment of idiocy is not m
opinion equal to the previous one ; it contains much that is chara(
terised by the same defects as we have already pointed out, withoi
being counterbalanced by the same discriminating sagacity. Thru
moral treatment of idiots is one of great importance, and gener-^s
success very much depends on the tact and judgment of the train^^
in this particular.

Some of the dicta laid down are more than questionable. We
cordially acquiesce, however, in the importance of commencing tic
moral treatment early, and the evil influence which is often exerterf
by injudicious friends. ''We have seen idiots, after a year 0/
obedience and contentment, relapse into their anti-social habits at
the sudden reappearance of the weak-hearted person who once in-
dulged their idiotic propensities, and the same children resume their
orderly habits at her exit.^'

Our author attaches importance to the advantage which idiots
derive from their companionship with one another, and our observa-
tions confirm his remarks. We have frequently seen an idiot child
in a family depressed and injured by the isolation of his life. He
may have been surrounded by brothers and sisters, but they held no
companionship with him ; even the youngest avoided a game with
the one who spoiled the sport. Bemoved to the company of his
peers, his sympathies are awakened, and a healthy emulation is esta-
blished, which if rightly used will lead to good results. Moreover,
the imitative faculties are more readily evoked in company with
others, and effects are obtained which it would be useless to expect
from isolated effort.

Equally important is the exercise of authority, and the insisting
on obedience thereto. We doubt, however, whether recompenses
are desirable to ensure obedience. We believe rather that the general
life should be made as pleasurable as possible, and that punishment
for disobedience should be by deprivation of pleasure. This is the

1867.] Reviews. 195

great element of success in the treatment of idiots^ and the skill of
the physician will be manifested in his perfect acquaintance with the
idiosjncracies of his patients^ and his ready knowledge as to the
particular deprivation which will most influence his charge. We
We witnessed curious failures from mistakes in this particular.
The idiot is to some extent a hero- worshipper^ and he loves to bask
in the sunshine of his heroes approval. That person will not be a
successful moral trainer of idiots who fails to exercise by the threat
of his displeasure one of the most potent punishments he can inflict.
He can only do this, however, by being consistent, truthful, and
loving, with a tender appreciation of all the traits of his patients,
and by holding the supreme place in their affectionate regard.

While agreeing with many of the principles laid down in this
chapter, we think some are not free from grave objection. Our
author, for example, insists that idiots should not take their
food in large groups, within sight of huge joints, in order to
avoid disgraceful manifestations. This we take as a type of an
entirely mistaken principle of action. We have known, from similar
motives, idiots placed in rooms with windows high above the floor,
compelled to live and sleep in places as bare as possible of fur-
niture, to eat from metal platters, and to drink from iron cups, in
orSer " to avoid disgraceful manifestations.^' Where can there be
any moral teaching with such a principle of action ! It should be
our duty rather to give them cups that can be broken, platters
which can be mutilated, furniture which can be destroyed, to place
food before them which they are not at once permitted to eat ; and
it is our further duty to teach our patients those habits of self-
control which temptation alone can bring into action.

The chapter on *^ Institution^' describes what Dr. Seguin con-
siders necessary for the collective training of idiots ; many of the
suggestions are extremely good, but others we are persuaded are
equally visionary.

The same enthusiasm which led our author to an exalted account
of the speedy results from the training, naturally leads him to con-
sider that no expense is too great in the trial.

However great our sympathy for the most afflicted of our species,
we cannot entirely disregard poUtico-economical principles. In this
Jespect one cannot but perceive that the details are elaborated by
one who has not had the responsibility of command.

Irrespective of these considerations, we cannot take the general
directions given as the best suited for the regulation of an institu-
tion. It is only fair to observe, however, that they have been
written with an eye to the peculiarities and conditions of American
training-schools, and have very httle adaptation to English institu-
tional requirements. We have met with very devoted officials, but
we have yet to make the acquaintance,of the matron, who after fol-

196 Eeviewi. [Julyj

lowing the servants and children all day, attending to the household
arrangements, to application of dressing and medicines, to the
execution of the prescriptions relating to individual diet, to the
clothing of each child each time it goes out, to its condition on its
return, to passive oversight during school, to presidiog over their
festivities, yet '^ sees everything is right at bedtimej in the middle
of the night, and in the early morning/'

The volume closes with a copious appendix, which contains notes
of cases, some being translations and others being transcripts &om
the report of persons engaged in idiot training.

We have endeavoured to give our readers a clear idea of the con-
tents of Dr. Seguin's work. In doing this we have had to allude
to points on which we differ, to call attention to errors into which
the writer, in our opinion, has been led by a too fervid enthusiasm.
We have not been insensible to its merits, to its earnestness, and to
its frequent pregnancy with thought ; but we have at the same time
felt that its importance and aims rendered it worthy of other than
mere indiscriminate praise. Its defects are radical ; it fails to teach
us anything of the pathology or morbid anatomy of idiocy, it
assists but little in the diagnosis of difficult cases which every now
and then arise, it gives no data on which to base a safe prog-
nosis, and throws no new light on etiology. As the work of 'the
physician, it is scanty ; as the work of the schoolmaster, it im-
presses us strongly with its value, makes us regard with kindly
admiration the warm sympathy which everywhere shines out, and
the enthusiastic love of the subject which is the origin of its gravest
faults. We have abstained from laying bare some of these faults
out of respect for the loving earnestness of the author. He writes
with some of the spirit of an old warrior, who gloats over campaigns
in the distant past. We warm as we witness the fire of his eye
and the mantling glow of his face. If, however, he is to lead us to
the battle, we regret that he has been deprived so long of the ballast
which practical work imparts. We feel convinced that we shall
require for our victory a fuller appreciation of the strength of our
enemy's position, and to reject from our equipment the weapons
which have only theoretic worth. In spite of these counterbalancing
aspects, we still retain, in large degree, veneration for the hero of
former fights, and are influenced by the recollection that it was by
virtue of the same enthusiasm which now imparts an exalted fervour
to his words, that prowess was given to his arms, and that he
stepped forward as the early champion of a noble but long-neglected
cause. J. L. H, Down.

1867.] Retfiew. 197

Lectures an Clinical Medicine^ delivered at the Hdtel-Dieu, Paris, by
A, TrotMseau. Translated and edited with Notes and Appendices
by P. Victor Bazire, M.D., London and Paris. London:
Robert Hardwickc, 1866.

It is aMays a great pleasure to us to peruse the works of our
continental brethren^ and we welcome the appearance of English
translations^ because they afford to English practitioners the oppor-
tunity of becoming acquainted with the observations of the con-
tineDtal faculty; they aid us in^ding the experience of some of
the highest intellects and keenest observers to our own ; they widen
the field of practice^ giving us materials for enlarged comparison^
whereby we increase our knowledge of facts; and they enable us the
more readily to judge between the investigations of continental
scientific men^ between the theories of our much gifted neighbours
ftod those of our own scientific labourers^ by which means done we
^ enabled to correct errors and eliminate truth.

Trousseau^ a physician of continental reputation, singularly gifted
^th the highest class of intellect and not inaptly styled the French
Graves, possesses in addition to his great power of observation the
facility of readily communicating knowledge* to others — ^more, he de-
livers his lectures in so charming a manner that he has long been
Recognized as the most popular clinical teacher in the Prench school,
and a noble ornament to the medical profession. For nearly half a
century, with truth as a fixed determinate object ever in view, and its
isolation ever his most earnest incentive. Trousseau has laboured
with most eminent success, and having earned his well-merited
laurels he has given to the world the result of his long and patient
investigations, and we would fain record our vote of praise and
acknowledgment of the service he has rendered. His translator
Bays of him —

" A fervent believer in the doctrine that the sole aim of medicine should
be the care of disease, and convinced that, bj a thorough knowledge onlj of
its ever-shifting, ever-varying phenomena can we hope to attain the means
of curing, or, at least, of alleviating it, he has devoted all his energies to the
acquisition of clinical knowledge. And to his task, it must be confessed, he
has brougbt a keen and vigorous intellect, rare soundness of judgment, and
immense powers of observation, as immense as the field in which he
laboured.

Perhaps the greatest compliment we can pay Professor Trousseau
is to say that he is no specialist ; that whatever branch of medicine
lie investigates the same philosophic spirit leads him to the most
careful observation of every attendant phenomenon ; and whenever

198 Reviews, [July,

Le discusses a particular disease he delights us with precisely defined
descriptions which tell of his intimate knowledge of every correlative
disorder.

That Professor Trousseau is a philosopher of no mean order we
cannot fail to observe, and this we learn from the intrinsic evidence
of his book. His candour is not less marked in his avowals of
those circumstances which have from time to time operated on his
mind in their moral bearing, than in his statement of facts and
inductions. '

To Dr. Bazire much praise is due : he states " that he has en-
deavoured to give a faithful translation of his author, without con-
densing or abridging in the least, or leaving out portions of lectures/'
and he has not only most happily succeeded, but has also maintained
the charming conversational style of the lecturer throughout. The
arrangement of the English editor also is wise and judicious ; the
immense importance and thoroughly practical discussion of the sub-
jects of the first four lectures have guided Dr. Bazire in giving them
the most prominent position, while the interest necessarily attaching
to the new subjects of glossolaryngeal paralysis, ataxia, and aphasia
entitle them to the next consideration. Dr. Bazire has added notes
and appendices, taken from the writings of our most eminent authors
and the results of his own experience; these are all carefully
considered and well selected, and are a valuable addition to the
book.

There is perhaps hardly a subject of more vast importance than
Epilepsy, and Trousseau's chapter upon it is unquestionably his
masterpiece ; for accuracy of observation and close reasoning he has
here almost surpassed himself, and has given to us the most valu-
able essay we have on the subject.

The author does not assert that cerebral hyperoemia is an impossi-
ble condition, but directly admits that the brain is as capable of con-
gestion as any other organ, and maintains that the symptoms usually
attributed to cerebral congestion are more allied to syncope, and are
often indications of epilepsy, eclampsia, or epileptic vertigo. The
distinctions that have been drawn between epilepsy and eclampsia
are simply and briefly these : — Epilepsy is a term used to express
convulsive seizure when no lesion is evident, as exampled in the so-
called idiopathic epilepsy, and the convulsion, when either tumour in
the brain or tertiary syphilis are suspected : — Eclampsia is a term
used to express convulsive seizure in the subjects of blood poisoning,
intestinal irritation, external irritation, or anaemia from haemorrhage.
The distinctions are much more apparent than real, and Trousseau
unreservedly declares that the affections, though widely different in
their nature, are identical neuroses, adducing irresistible arguments
in support of his opinion. The symptomatic expression and the

1867.] Heviews, 199

proximate cause in both affections are the same ; but this proximate
cause now does^ and perhaps always will, escape discovery, while the
post-mortem appearance of the brain, in all cases where the indi-
vidual has died in the convulsion, is merely vascular congestion. The
convulsion of pregnancy in a woman long subject to epilepsy is not
distinguishable from the convulsion which sometimes immediately
ppecedes labour ; neither is the convulsive seizure associated with
tubercle, cancerous and bony tumour, or the convulsion of a child
suffering from worms or from scarlatinal dropsy, in the least
different from an epileptic fit. And our author affirms his beUef
that the molecular condition of the brain and spinal cord is the
same whether the fit occurs under the category of eclampsia or
of epilepsy. Trousseau, to use his own expression, is an organicist,
and, in the firm conviction that functional lesion cannot occur with-
out tissue modification, regards every case of epilepsy, or of eclampsia,
as symptomatic ; all convulsive seizures being the expression of the
same intimate modification of the central organ, whether due to
tumour, poisoning, anoemia, external irritation, or some inappreciable
organic condition. In treating, however, of epilepsy our author
confines himseK to the discussion of the subject as defined, separating
from it all those forms of convulsive seizure to which the term
eclampsia has been applied; and his description of a fit, which deserves
the most careful study, is, without exception, the most perfect we
have of this truly profound disturbance of the animal frame : we
give it in extenso.

*' All of a sudden, without auj premonitory symptom, the patient utters a
loud scream, and falls usually on his face. This is already an important
fact, and characteristic of the real disease. ♦ ♦ ♦ ♦ xhe true epileptic
is thrown down with such violence, that his head knocks against any obstacle
in the way. Sometimes he falls backwards, or on one flank, but in most
cases, I repeat, he falls forwards, and it is therefore, on his nose principally, his
forehead, his chin, his cheeks, — in a word, on the prominent portions of his
face, that you will find either actual wounds, or scars of old ones. Fractures of
the skull, or of the bones of the extremities, dislocations, may also be caused
by the fall. In some cases the patient falls into the fire and burns himself
fearfully ; instances even have occurred of persons found burnt to death,
after falling into the fire, and whose faces were so charred as to be no longer
recognisable.

'* When down on the floor, the patient presents symptoms which should be
carefully studied, because, although they do not last long, they are yet very
•characteristic. As he falls down, the epileptic is not red, as has been
wrongly stated, but deadly pale ; and this is another phenomenon which is
necessarily absent in feigned epilepsy. Convulsions then begin immediately.
They are tonic at first, consisting in a powerful contraction of the muscles,
irhich are in a state of violent tension, without alternate relaxation. They
are more marked on one side than the other, a character of great value
in an epileptic fit, because rarely absent. Sometimes even they are limited
exclusively to one half of the body. You will see, for instance, one
arm twisted on itself and drawn backwards, the hand flexed, the thumb
forcibly adducted and hidden by the fingers, which are bent over it into

200 Reviews. [July,

the palm. The lower extremity is also oonTulsed ; the foot is arched, and
extremely tense ; the leg is forcibly extended and twisted on itaelfl The
muscular rigidity b not to be overcome, and although they contract con-
vulsively with a certain degree of slowness, the muscles are agitated by qui-
vering of their fibrillse, which can be easily felt. To the hand they feel as
bard iron. The twisting and forcible pronation of the limbs are so violent
that injuries may result ; and I recently saw a case of spont-aneous disloca-
tion of the shoulder which had not occurred at the time of falling. Such
injuries may be inflicted in nocturnal attacks, occurring during sleep, and I
shall by-and-by dwell on their significance as regards diagnoses.

'* The muscles of the thorax and abdomen are in a state of tetanic rigidity,
and the respiratory movements are completely arrested. After these tonic
contractions have lasted a few seconds, and the thorax remained perfectly
motionless, the face besins to redden ; and it is then, and only then, and not
when the individual fidls, that the veins of the neck get distended, and that
the face turns livid.

" At the time when tonic convulsions affected the muscles of the limbs
and trunk, the tongue violently thrust forward from the involuntary con-
traction of the genio-hyo-glossi, protruded through the half-open jaws,
swollen and purplish, but not yet cut or wounded by the teeth.

*' This may be termed the first stage of an epileptic fit, or stage of tonic
convulsions. It lasts from ten to forty seconds at most, and the second
stage, that of chronic convulsions, then begins. The limbs are alternately
flexed and extended, and it is this stage which characterises the epileptic fit
with which every body is familiar. It lasts from half a minute to two
minutes at the most, so that the whole duration of the attack varies from
two to three minutes, and in most cases less still. In most cases it is in the
second stage that the tongue is wounded

*' With the clonic convulsions ends the convulsive attack proper ; but the
patient then falls into an apoplectiform condition. His breathing is ster-
torous, and during expiration his half-opened lips give issue to frothy saliva,
which is tinged with blood. For a length of time, varying from a few
minutes to half an hour, he remains in this condition of profound stupor
and complete immobility."

It is in no small degree surprising that the deadly pallor of
epilepsy should have been so generally overlooked, and that the
second stage, that of reddening of the face and distension of the veins
of the neck should have been so universally regarded as the primary
and essential condition. There is little doubt that this error in the
first instance gave rise to the impression, that the primary and excit-
ing cause of epilepsy was a congested condition of the cerebrum,
and, having been taught in the schools, became perpetuated ; and
practitioners have been led to observe closely the congested stage
with its succeeding phenomena to the disregard of those antecedent.

The evidence of the anoemic condition of the brain at the invasion
of the attack is almost conclusive. The deadly pallor is one irre-
sistible ground of argument — for we must, however unwillingly,
arrive at the conclusion that the whole of the vessels of the head
share the condition of those on its surface — when we compare it
with conditions in which congestion of the brain in a high degree is
indicated by the vascular congestion of the surface of the head. In

1867.] Reviews. 201

instances such as a woman in labour^ or a child in a violent fit of
whooping-cough^ the face becomes blue^ the lips and eyelids swells and
hemorrhage from the nose may even occur^ yet we do not get a fit^
though there cannot be any doubt about' the brain participating in the
hypenemia; and a most confirmatory argument is adduced from the
bet, that animals when bled^ and when there cannot possibly be
sufficient blood left in the vessels to congest any organ^ usually meet
death in an epileptiform convulsion.

Trousseau's view of the anoemic condition of the brain in the first
stage of epilepsy does not stand alone, many observers having for
some time past inclined to this opinion^ and Dr. Brown-Sequard has
demonstrated by actual experiment that at the onset of the attack
the great nervous centres and the medulla oblongata become paler.
We give the description of the phenomena, as detailed by the last-
named eminent and independent observer, which cannot fail to strike
the reader, so closely do they confirm those noted by the author
before us.

1. Contraction of blood-vessels of the brain proper and of the face,
and spasm of some muscles of the eye and face.

2. Loss of consciousness, and accumulation of blood in the base
of the encephalon.

8. Tonic contraction of the laryngeal and cervical, and the
thoracic muscles.

4. Crying and stoppage of respiration.

5. Tonic contraction extending to most of the muscles of the
tnmk and Umbs.

6. Palling.

7. Asphyxia, with obstacles to the return of venous blood from
the head and spinal cavity.

8. Clonic convulsions everywhere, contractions of the bowels,
the bladder, the uterus ; erection ; increase of secretions ; efforts at
inspiration.

9. Cessation of the convulsions ; coma or heavy sleep, and, after
these, extreme fatigue and headache.

The fact of loss of consciousness is of high importance and is
more the one characteristic of epilepsy than the convulsion, and
Trousseau's cases of epileptic vertigo are of great interest as illus-
trating this part of the subject.

Another important characteristic upon which too little stress has
t>een laid of late times, and to which Trousseau draws particular
attention, is the ecchymoses attendant upon epilepsy. He says —

** If you examiiM ap epileptic carefully after one of his fits, or, better still,
leveral hours afterwards, you will often find on his forehead, his throat, and
chest, minute red spots, looking like flea-bites, which do not disappear on
pressure, aod have aU the characters of ecchymoses ; not only are the small

202 Reviews. [July,

red ptmctsB observed, but large ecchjmoses also, •which are produced in the
same way, and apart from all contusion. This sign is, I repeat, of consider-
able importance, for the ecchjmoses are a sure sign of an epileptic fit."

The characteristic ecchymosis is of especial value where diagnosis
is obscure ; and the more so now in the medico-legal point of view,
since the question of responsibility of epileptics is occupying so
much attention. We cannot enaorse M. Jules Falret's opinion
when he declares that an epileptic is an irresponsible person: an
epileptic may be, and many epileptics are, irresponsible, but even
this IS only true within certain limitations, and does not warrant the^
proposition — epileptic, er^o irresponsible.

Trousseau gives us a very valuable lesson on the point, one that
should sink deeply into the mind of every medical man, one we have
too little considered, and one that humanity and the interests of
society require us to study calmly and fairly, as it points to truths
which we are called upon to embrace resolutely — ^truths which, could
they be shown, would doubtless cause our legislature to save many a
poor helpless and well-meaning sufPerer from the ignominy of the
scaflFold, and ourselves from the slander and reproach we now bear
by reason of our legal definition of responsibility. Would that our
so-called experts made themselves masters of plain facts, as Trousseau
has done — ^the surest means of carrying truthful conviction into
our courts of justice and the first and only means of reUeving the
profession of the scandal, that ^'experts go forward in hopeless
ignorance to try and obfuscate judge and jury, while counsel drive
them out of court with word-bemuddled brain, the luckless unfor-
tunate and often innocent accused falling a victim to their verbose
wrangle. Trousseau's chapter on the relations of epilepsy contains
numerous quotations from Jules Falret, bearing directly upon the
association of epilepsy with responsibility, but our author clearly
and distinctly asserts that a culprit, because he is epileptic, is not
thereby exonerated from all criminality. Epileptics, not insane
during the intervals of the attacks, undoubtedly are often great
criminals in the moral acceptation of the word ; they are responsible
for premeditated acts, because in these they are free agents and
amenable to law : but, says our author —

'*If an epileptic has committed murder without any possible motive, with-
out profit to himself or any other person, without prepieditation or passion,
openly, and consequently in a manner quite different from that in which
crimes are usually committed, I have a right of affirming before a magistrate
that the criminal impulse has been the result, altnost to a certainty^ of the
epileptic shock. I would say almost if I had not seen the fit ; but if I my-
self, or others, had seen a fit, or an attack of vertigo immediately preceding
the crimmal act, I would then affirm most positively that the culprit had
been driven to the crime by an irresistible impulse.'*

We give the case with which Trousseau illustrates the above, it is

1867.] Remews. 203

a sample of a class not uncommon, but unfortunately but too seldom
recognised :—

" A ;^oung man, whilst on his way to the Palais Royal, in company of
some friends, with whom he was going to dine, suddenly falls down on the
* Place Louvis,' but soon gets up again, andjrushes on the passers by, striking
them with violence. He is taken to the police station, and for some time keeps
insulting the soldiers who hold him, and spitting in their faces. Now, had
there been no witness of the epileptic attack which had preceded this extra-
ordinary scene, and had not the physician (Dr. Jozat) who related the fact
to me interfered, the young man would have been tried for rebellion against
the police authorities. It will be easily conceived how difficult it is to arrive
It the truth when the epileptic and the victim of his violence have been quite
alone."

We cannot leave this subject without one word on the treatment.
Trousseau having gone through the list of drugs commonly employed,
pledges his faith for alleviation, and in some instances for cure, on
belladonna, which he speaks of as the least inefficacious of tried re-
medies. He omits to mention bromide of potassium. This omission
is strange since bromide and iodide of potassium, either alone, or
together, have within the last few years been so extensively used
with such evident benefit. Dr. Bazire has however added a full
and valuable note upon the use of bromide of potassium, con-
densing the experience of Drs. Brown-Sequard, Eamskill, Ead-
cliff, Hughlings Jackson, and himself, at the National Hospital for
Paralysis and Epilepsy : he says, " The results obtained are such as to
warrant the conclusion that it is infinitely superior to all the other
remedies that have been recommended.^' Trousseau lays down, how-
ever, a rule for treatment, which is undoubtedly the essential of
therapeutic influence over this fearful malady. ^^ When a disease
has penetrated the organism, when it masters its whole substance as
it were, one cannot pretend to silence its manifestation, to cure it
within a short space of time — a chronic disease requires a chronic
treatment.'^

To Dr. Wilks, of Guy's Hospital, the profession is perhaps in-
debted for the earliest observations on the use of bromides and
iodides in epilepsy, and the modest claim he lays to early observa-
tion on these highly valuable and important remedies, in a foot-note
to his striking and able paper in Guy's Hospital Eeports for 1866,
Pp. 2S1, fully merits the notice which we most happily give it here.
Our high estimation of Trousseau and his work, and our review of
the latter would be unfair were we to omit to remark that many
physicians in England have been in no small degree surprised, and
8ome not a little incredulous, regarding some of the maladies which
l^usseau has included under partial epilepsy, and of those distress-
ingly agonizing conditions which we call angina pectoris, painful
^asm of the face, tic-doloreux, neuralgia, which the eminent French
pnysician regards as expressions of the epileptic condition.

204 Beviews. [Jnlj,

The evidences^ though not absolutdy conclusive as to the central
modification^ certainly show that there is a departure from the nor-
mal condition of healthy tissue^ while the paroxysmal recurrence at
least indicates the proxunate cause to be allied to that of epilepsy;
and the manifestabon certainly simulates the epileptic aura.

Trousseau says :

*' There is a form of paralysis which is always progressive in its conne,
fatal in its termination, and which is marked, at its onset, by a diminution of
motor power in the tongue, the soft palate, and the lips. I give to thii
affection the name of glosso-laryngeal paralysb, in order thereby to indicate
the principal symptoms which characterise it."

The comparative newness of the subject renders it interesting in
an eminent degree ; the disease certainly is not new^ as our author
states, but like progressive locomotor ataxy, and progressive mus-
cular atrophy, it was confounded with other forms of paralysis till
Dr. Duchenne isolated it. Trousseau disclaims priority as to the dis-
covery of the morbid process, but to his genius certainly is due the
credit of the first observation of the progressive tendency of the dis-
ease. He details his first recorded case, that of Prince M— ,
pp. 117 and 118, which, as well as those given in the succeeding
pages, is full of instruction, the diagnosis between this and genenu
paralysis is singularly interesting.

"The general paralysis of the insane sets in, it is true, with an embarrass-
ment of uie tongue ; but there may be noticed, at the same time, slight con-
vulsive trembling of the lips, and in most cases delirium is observed from
the beginning, together with a fixed stare, which is never met with in the
patients whose cases 1 related to jou. Besides, in glosso-laryngeal paralysis
the intellect is always perfectly clear, and the patients soon find out the
gravity of their complaint ; whereas, this is not the case in the paralysis of
the insane. Again, m this last affection, if sooner or later general feeUeneai
of the muscular contractility be observed, in no case does thb paralysis
affect specially the muscles of the soft palate, nor is there ever dribbling of
the saliva ; whilst from the beginning the practitioner is led, on account ofthe
failure of the intelligence, to locate the disease in the brain/'

Diphtheritic and double facial paralysis may be confounded with
this neurosis ; but, as our author says, the history of the former will
sufficiently suggest the nature of the case, and in the latter the im-
mobility of the tongue and the muscles of the face are certain to
decide the question.

We are daily learning more of the natural history of Pbogbessivb
LocoMOTOB Ataxy, and since we have so advanced in our knowledge
of this subject so full of interest, and since so many intellects of the
highest order have devoted themselves to it with such energy, may we
not indulge a reasonable hope that we may be enabled to discover
means to relieve, if not to cure, a disease the pathology of which we
pride ourselves we are beginning thoroughly to understand P

1867.] Reviews. 206

Ever ready to give credit where credit is dae^ Trousseau rendeii
most gracefully to Dr. Duchenne (de Bologne) the palm^ as the first
to bring up this disease out of the confused mass of conditions
included under the head of paralysis^ and adopts Duchenne's
term Progressive Locomotor Aiary^ because it sufficiently indicates
the condition. Of the other names which have been proposed,
viz. : — Tahes dorsalis, and Atrophy of the posterior columns of the
cord, he says the first has only its antiquity to recommend it,
while the second is as long as Duchenne^s and is not as precise as
its advocates would have us believe. Dr. Bazire says, in a foot-note
"The word Asgnergia would be better than that of Ataxy, which
has already a definite sense in medical language, different from its
meaning in Locomotor Ataxy ; but as this latter term has been uni-
versally adopted in France, I have hesitated before changing it.^'
And we cannot but agree that he is vnse in his hesitation. It is
very evident that, whatever be our advance in the pathology of the
disease our author treats of in this chapter, we have not as yet
nearly reached the whole truth ; and while we thus remain in gross
darkness we shall exhibit more wisdom by retaining a name which
gires a fair and clear idea of evident phenomena, than by seek-
ing to fix arbitrarily a name upon pathological appearances which
we so often find in strange contradiction to our anticipations,
and to the preconceived conclusions drawn from symptomatic ex-
pressions.

Undoubtedly we have advanced in knowledge greatly by our study
of Progressive Locomotor Ataxy, but the advance has taught us that
we must unlearn much of our former acquisitions. The atrophy of the
posterior columns and the degeneration of the posterior nerve roots,
with impairment of motion but perfect retention of sensation, cer-
tainly point to some imperfection in the teaching of Longet : at all
events the posterior columns and their corresponding nerves are not
wholly, if at all, the conductors of tactile impressions, and while
physiological experiments so clash with pathological observations, and
wBle such experimenters as Brown-Sequard, Turck, Philippeaux, and
Vnlpian, achieve results which are contradicted by the experiments
of other investigators of equal ability, as Leyder and Eosenthal, we
can but feel the force of Trousseau's remark, ^' The contradictory
statements of savants of acknowledged merit are only an additional
pfoof that, as regards the functions of the spinal cord and the nervous
system in general, physiology has not said its last word/'

Om: author adverts to the fact that microscopical examination has
8lK)wn that some of the fibres of the posterior nerve roots have in
some cases been found intact, from which some have advanced the
^eory that those healthy tubes extend their sphere of influence
%ond their sphere of action, and thus supply the place of those
^ have disappeared ; he, however, says, ^' The anatomical fact

VOL. xni. ' 18

206 Reviewi. [Juty,

cannot b« dispntcd, but the inference drawn from it is Tery question-
able/' And in drawing attention to the bearing of the results of ex*
periments of Brown-Sequard and others, upon the pathological
observation that the posterior columns immediately influence thd
co-ordination of motions, he does not fail to notice that Dr. Oullbtt
propounded the late Dr. Todd's view regarding the posterior columm
as the centre of the faculty for co-ordinating voluntary movements.
— Oui^s Reports, 1858.

Trousseau tells us that his idea of the disease, notwithstandii^the
grave organic lesions revealed by inspection, is, that it comes under
the great class of Neuroses or functional disturbances, ^' because the
lesions found by no means account for all the symptoms.'' This
statement may seem to call into question a fixed principle of our
author allready aluded to, viz. : '^ that afimetional disturbance, t^
out a corresponding and special modification of the organ disckatgik§
that function, cannot take place*, but it is only fair to remai^ that
he qualifies his opinion that Progressive Locomotor Ataxy i« not
dependent on material lesion found, explaining that he refers in the
expression only to '' lesions which can be detected by our present
means of observation." The modification, he says :—

"maj be more or less transitory, and it frequently does not alter the
structure of the or^an any more tnan an overcharge of electricity alters the
structure of the glass or metal of a Leyden jar, and it therefore remains per-
fectly unknown to us. Now, as regards progressive locomotor atazj, the
fact that the lesions on which it is said to depend are not so constant u it
has been positively affirmed, is an argument in favour of my opinion. In
some cases, although ataxy had been present for several years, and been
attended with most distinct and characteristic symptoms, skilful anateidi^
have not been able, either with the naked eye or with the aid of the nicro-
scope, to make out the slightest alteration of the posterior columns and
roots.'*

The cases are rare and exceptional, but our author brings forward
one obs^ved by Dr. Gabler, and diagnosed by Dr. Dtichenne, as s^
typical case of Progressive Locomotor Ataxy, and in which on
inspection the posterior columns were not found to be atropfaieid,
but, on the contrary, about one third of the anterior lumbar and cer-
vical nerve-roots had disappeared. We leave this most int^est-
ing subject with some conviction that Trousseau wad probably
nearer the truth than other writers on the subject, when he
declared that " The post-mortem appearances of Progressive Loco-
motive Ataxy were not the cause, but the effect of the disease."

'Hie int^est which the subject of Aphasia has of late yeais mad^
for itself was no doubt Trousi^eau's inducement to devote a long anc
inistructive chapter to it. In the opening pages he details man;
cased presenting Aphasia in its varied forms; on one case tha^
of a patient in H6tel-Dieu, of the name of Marcou, he kys som-
stresfl^ as an instance of Aphasia with left hemiplegia, being, a*

1867.] fieviewi, 207

&r as he was aware, the only one of its kind then on record. These
cases are rare it is true, but several have been well authenticated,
and two are quoted by Abercrombie. It has been said that these
OBses have always occurred in left-handed people, and Dr. Moxon in
aiable, original^d yeiy suggestive paper in the Medico-Chirurgical
Beview, endeavour i§ to show, that education determines the spot in
vhich tiie memory of words is localised, and that as only one side of
our body is parti(iularly educated, dpeech with the other functions is
confined to one side ; therefore, any central lesion involving the func-
tions of the educated side should also involve speech. Now it is not
ptoved that because we often use our right hand more than our left,
all the right sided organs share the same superior education. In
1820, liordat ascribed Alalia to a defect of co-ordination of the mus-
d^ used in the act of speaking, but did not attempt to specify the
partof the bram,aninjurytowliichmightcause loss of speech. Gall con-
jectured that the faculty of articulate language was located in the
tfdterioi' lobes of the oi^ain, and Dr. Bomllaud was led by clinical
dbsettation to locate this fetculty in the frontal lobes. In 1836, Dr.
Ifarc Dax localised the memory of the signs of thought in the left
half of the brain. In 1863, Dr. G. Dax tried to prove that the
lesion concomitant with Aphasia, was invariably seated in the anterior
and outer portion of the middle lobe of the lefk hemisphere,
thns locating the seat of the language organ very near to the island
of Eeil, the spot indicated by Dr. Broca. So many and diverse,
however, have been the observations of numerous investigators of
ilus question, that iSrousseau gives a guarded though very judicious
aomming up, derived as much or more from chnical observation
Ulan from post-mortem inspection.

''In ftpbasia th^t^ is not merely Id^l of speech, but there is also impair-
ment of the understanding. The patient has lost simultan€k)usly, in a greater
or less degree, the memory of teordSf the memory of the acts by means of which
Words are articulated, and intetiiaence. Aphasia consists in loss of the faculty
of expressing one's thoughts dv speech, and in most cases also by writing
^d by gestures. As every distmct faculty presupposes a special organ, the
advocates of looidisation made out that the seat of this faculty in the brain is
the posterior portion of the third frontal convolution, chiefly on the left
•ide. But the ikiost ir^ed l^ions of this dpot, and I w|ll add, of neighbour-
ing parts, more deeply situated, suck as the insula of Reil, and the corpus
stmtum, daii bring on aphasia."

In bidding adieu to this book, we catiriot too highly recommend
it to the careful perusal of our brethren. The fact that the elegance
of composition of the original has been so well maintained by the
translator, gives it an additional claim to the success which we
hcaitily wi& it. J.T.D.

208 Beviewi. [Mj,

Die Pathologie vnd J%erapie der Piyekischen KrankeitenfMr Aente
und Studirende von Dr. W. Oriesinger, Prafeuor der Medidn
und Director der mediciniscAen Klinih an der UnivereiUU Zurich,
Zweite, umgearbeitete und eehr vermehrte Auflage. Stuttgart;
1861, pp, 538.

Trailddes Maladies Mentalee, Pathologie et Therapeutique. Par W.
Obibsinger. Traduit de l^Allemand (2nd edition), sous les
yeux de TAuteur, par le Dr. Doomic, M^decin de la MaisoA
Centrale de Poissy. Paris, 1865, pp. 502.

Mental Pathology and Therapeutics, By Professor W. GsiesingiiRi
M.D., &c. &c. Translated from the German (2nd edition) bj
G. Lockhart Robertson, M.D., Cantab., and. James Butherfordi
M.D., fecUf^, Published by the New Sydei;diam Sodetj.
London, 1867,K8|k 524.

{Second Notice.)

In the last number of this Journal (April^ 1867) we endeavoured
to present a review of the first and second books of Professor
Griesinger^s treatise on Mental Pathology and Therapeutics, the
English version of which by the New Sydenham Society is now ready.

There remains for notice on the present occasion the three con-
cluding books of this work.*

Book III. — ^Treats of the Foems op Mental Disease.
It consists of four chapters, viz. —

Chapter I. — The States of Mental Depression ; Melancholia.
Chaptee II. — ^The States of Mental Exaltation ; Mania.
ChapteA III. — ^The States of Mental Weakness.
Chapter IV. — On several important complications of Insanity j
General Paralysis, &c.

This third book on the Forms of Mental Dlseasb occupies no
less than 200 pages of the New Sydenham Society's Translation.

* The work is divided into the foUowing five parts : — Boox I. Ghneral cmS
Iwtroductoiy to the Study of Insanity,— Book II. The Cauee and Mode of Oriyit^
of Mental IHsease,— Book. III. The Forms of Mental Dis^cue. — Book IV. Tk0
Pathology of Mental Diseaac^BooK V. The Prognosis and Treatment qf Mental
Disease.

1867.] Remew9. 209

The first chapter on the Statbs of Miottal Depebssion, MELAjr<«
CHOUA is divided into —

.Section I. — H^pocAondriasis.

-Section II.' — Melancholia in a more limited sense.

Section III. — Melancholia with stupor.

Ss^bnciN \Y .-^Melahcholia with destructive tendencies.

a. Melancholia with suicidal tendencies.

b. Melancholia with distructive fknd murderous tendencies.

Section V. — Melancholi^jcith^ persistent excitement of the wiU.

The description of these several form's of Melancholia are accuratelj
drawn from life with marvellous skill. We much regret that our
Ihnits compel us to limit the length of our extracts from the text.
Each form of the disease is further illustrate by a series of striking
cases culled from the wide field. of Professor Griesingelr's readings in

Psychology. ' . :\ \

*• ■ ' ' ' ■ . ■. '

Tbe second chapter of Book III treats of the States of Mental

ExALf ATION.

It is diMded into *tw6 siectionsy vvt. —

Section I. — Mem^i. I ^

a. With anomalies of the disposition^ of the desires^ and of

the will.
h. With anomalies of the int^ect.

c. With anomalies of sensorial function tmd of movement.

Section lS..y^Mowmania. '

a. With anomalies of self-consciousness^ the desnres and the

will.
J. With anomalies of the igiielligwice.
c. With anomalies of the sensorial fhnctions^ the movements

and the conduct.

The third chapter of Book tll treats of the States of Mental

Vbaxnbss.

Under this head are includedr-

Sbotion I. — Chronic Mania {JDie VerrUcktheit ; La Folic
systSmatisSe).

Under this term are comprehended those secondary states of in-
sanity in which^ although the original morbid state of the sentiments
has considerably diminished or even entirely disappeared^ the indi-
vidual does not recover^ but remains affected in such a manner that
(he delirium is now most strikingly exhibited in certain fixed delirious
eonceptions^ which are cherished with especial preference and cour

210 ReviewB. [July,

stantly repeated — always, th^refore^ a secondary disesise developed
out 0^ mmncholia or mania.

These deviations from the healthy standard may be ctivided into—

1. Anomalies of Self-consciousiiesSji t}ijs Pe^ires and t^^ Will

2. Anomalies of thought,

3. Hallucinations and illusion^ pf ^ t)i^ prg&n? pf W^'

Sbction II. — Dementia.

Section HI. — Apathetic Dementia.

Section IV. — Idiocy and Cretinism.

This form is divided into —

1. Idiocy in general.

2. Endemic Cretinism.

Chapter IV of this Book (III) is devoted to 9ev^^l Impo^taot
Complications of Insanity. Of these disorders, the ^-#<^
general {incomplete) paralysis, on account of its frequency, the
peculiarity of its course, and its highly ui^avorable prognosis^ m^ts^
says Professor Griesinger, the greatest share of our atte^tion.

As the second important complication of insanity he mentions
epilepsy.

Many other morbid appearances in the motory nervous sysim^ SAay
also complicate insanity. Sometimes transitory general convulsive
states resembling hysterical attacks, or proceeding fi?om great cerebral
congestion or acute meningitis j sometimes chronic general convulsive
forms, chorea-like movements, turning round and round, walking
backwards or in a circle, and the like ; sometime^ chronic convukions
restricted to certain muscles, — ^for example, constant convulsive
nodding of the head, convulsive lifting of the leg when walking,
&c. ; sometimes contractions of certain groups of muscles (of the
extremities, strabisn^us), with or vnthout paralysis, succeeding.

Book IV treats of the Pathological Anatomy of Mental Dis-
ease. It consists of two chapters^ the first treating of tl^e patho-
logical anatomy of the brain and its membranes ; the secgncl of H^i
pathological anatomy of other organs.

The following extract is a good sample of Professor Griesinger's
power of summing up the dimculties of any question, and also pre
sents in their true light, the results as yet attained in the study o
the morbid anatomy of the brain : —

The anatomical changes which indicate insanity, that is, whicli produce
psychical anomalies during life, are naturally to $e sought for within th<
cranium — in the brain and its membranes. According to the data which wi
at present possess, it is a well-constitu1|ed fact, that in the bodies pf manj
persons who have been insane no anomalies in these parts are to be found
If we examine the great mass of uncertain records, and exc^^ the cases ii

1867.] * Seviews. 211

which the insanity was cured before death, there still remains a number of
cases, reported by careful special observers (and which may easily be con-
firmed in any asylum), where the cranial cavity and its entire contents
presented altogether normal relations.

We ought to be quite as grateful to pathological anatomy for the confir-
mation of this fact, as for the discovery of anatomical lesions. For although
in all cases of insanity we must assume a pathological affection of the bram,
there is thus presented to us by these negative results, on the one hand, the
strong analogy of cerebral disorders without anatomical changes to many '
affections of the spinal and peripheral nerves, in which there is likewise no
anatomical lesion of the tissue ; and, on the other hand, we thereby obtain
trustworthy data for our prognosis and treatment.

But, in order that we may not form false conclusions from the fact that
cases exist where no anatomical changes are present, it must be particularly
borne in mind that, according to the statistics of recent careful observers,
these cases always constitute the minority. We must climate their numbers,
Bot by the statements of those physicians who, though perhaps excellent
administrators or theorists, have had no opportunity of studying the struc-
ture of the brain and its pathological changes— "Wbo understand merely how
to make a rough section of the brain with scapel and forceps, and, of course,
constantly find nothing. We must consider how easily many very minute
bat, nevertheless, important changes — even exclusive of those which are
osly microscopically appreciable — may elude mere ordinary attention, and
ve ought, as a rule, to accept statements regarding the normal or abnormal
condition of the brain from those only who, by the whole spirit of their
Writings, show that they are acquainted with pathological anatomy, that they
acknowledge this pre-eminently, and that they know what is to be looked for
and what is to be esteemed. Besides, in more recent times, the discovery of
previously unknown chaises, and a more definite anatomical and logical
mvestigation of purely known facts, have tended ereatly to promote the
pathological anatomy of the brain ; and just as we Enow for certainty that
much that is important was overlooked by the old investigators, so may
we anticipate still greater results from still more searching and minute
mvestigations in the future.

Kot only should these negative results, however, but even their theoretical
application and the conclusions derivable from them, be received with favour.
We must be careful not to underrate their importance on account of the
occasional absence of anatomical changes after death, and to conclude that,
for this reason, such anatomical lesions when present may not be the cause
of the mental disorder. That would be similar to reasoning of the following
nature : because cough and dyspnoea occasionally ezist without any anato-
mical changes in the lungs, therefore in pneumonia these symptoms might
not be the results of this pulmonary affection ; because convulsions, spasms,
paralyses, sometimes exist without organic change in the spinal cord, there-
fore, in cases of inflammation of the spinal cord, the convulsions, spasms,
paralyses, &c., are not the direct results of this inflammation, but it is more
probable that they have some other and unknown cause I Indeed, the mere
discovery of any abnormal cerebral condition is only the first step in advance ;
and we must not rest content with this, or expect to recognise m every such
anomaly the particular disorder from which the individua^psychical anomaly
directlv springs. A knowledge of the inl^imate connection between t^ind of
alteration anq form of psychical disease has not yet been arrived at. It is,
however, of great importance to discover whether in concrete cases palpable
indications of disease exist in the crania of the insane, what they are, what
i^^peanpices they bear, and how their form in general is related to the
appearancQ Qf the mental affection as a whole.

212 Reviews. [Jiily>

Autbenic reports of autopsies in which the condition of the bnun is
stated to be normal arc principally those of cases of uncomplicated recent
insanity, in the forms of melancholia and mania ; and, as a rule, ^anatomical
changes are frequent in proportion to the duration of the mental disease,
according as it presented symptoms of mental weakness, particularly of pro-
found dementia, and, finally, according as it was complicated with paralysis.
Still, cases presenting considerable acute anatomical changes ocCur as recent
cases of primary insanity (for example, the mania of acute meningitis) ; and,
again, many reports of autopsies of cases which correspond to chronic cases
of dementia and advanced imbecility show an entire absence of any anatomical
anomaly. Indeed, even of the most severe mental affection known, paralytic
dementia — in which also, generally speaking, by far the greatest and most
constant lesions are found — there constantly occur -cases where nothing
abnormal can be discovered by the methods hitherto in ordinary use. In the
present state of science, such cases must be considered either as rare isolated
observations, such as' occur in many other departments of pathology, and
hitherto beyond the reach of theoretical interpretation, or they must be
accepted as proofs of the fact that even the most profound weakness of the
psychical processes and of the motory acts may occur without change of
texture in the brain — anabgous to what is sometimes presented in the spinal
cord ; or — and this is especially applicable to the last-mentioned case — we
must, according to a well-founded analogy, assume, that as when the naked
eye can observe little or nothing, still the microscope may probably reveal
important changes, so from future advances in such methods of research still
further results may with confidence be expected ; certainly, therefore, many
of these cases ought to be viewed as affording only apparently n^ative
post-mortem results.

A consideration of the pathological changes in mental disease,
shows (observes Professor Griesinger) that the principle expressed in
the statement made by Esquirol towards the end of his famous
career (1835), viz., that pathological anatomy has done nothing
towards establishing the material conditions of insanity, no longer
holds good ; it may even be admitted that from the pathological
anatomical stand-point of that time something definite be said re-
garding mental diseases. Keeping in view the great and well-con-
stituted results, negative as well as positive, and altogether exclud-
ing rare and more isolated observations, he attempts in the following
summary, to compare the various states of psychical disease with
the anatomical conditions which most frequently correspond to them.
With this view, he divides the variou* cases of insanity into three
classes: 1st, Acute recent cases of melancholia and mania; 2nd,
Chronic cases of protracted, exhausting melancholia and mania,
partial dementia, and dementia; 3rd, Paralytic dementia. We
give this valuable summary in full : —

I. Acute Insanity. — (1 .) As in a considerable number of cases of acute
insanity the brain, on anatomical examination, appears perfectly healthy,
it must, in the present state of science, be assumed that the symptoms
very oflen depend upon simple nervous irritation of the brain, or upon
disorders of nutrition which are as yet unknown.

(2.) When palpable disorders exist, they consist chiefly in anaemia, with
more or less serous infiltration, or (more frequently) in hjrpenemia of the

1867.] Reviews. 213

• • • .

entire brain^ and particularly in simple and ecchymotic hjpenemia of the
delicate membranes and cortical grey substance. These hypersemias appear
sometimes to produce, and at other times merely to accompany, other morbid'
processes of nutrition .yrhich lead to further consequences.

(3.) This hj^ersemia is frequemtly accompanied by thickening and
opacity of the membranes, the result of chronic stasis. Tnis mayj in certainf
cases ^roOe^ from the same causes as the hypersemta itself ; in others,'
however, it may* be the result.

(4.) There is no constant distinct anatomical distinction between melan>^
cholia and mania: the disorders in^both forms are, nevertheless, not entirely
identical. . .

(5.) in meTanchoIifi'the brain appears perfectly healthy more frequehtly
than in mania; when an anatomical lesion exists, it does not consist in
hyperseoiia so fr€k;[uent]y as in mania, but rather in anaemia with greater
consistence of the cerebral substance, or with more or less serous infiltration.

(6.) Maniii presents more rarely than melancholia no lesion or sin^ple
hyperemia. The hypersemia is mote profound and more intense (sometimes
attaining to an erysipelatous hue of the efntire grey cortex), and it more
frequently^'proceeds to inflammation and softening, which affects the cortical
substance in Only certain layers, sometimes the middle, sometimes the external
layers. The rapid occurrence of extended softening of this kind ft'equently
corresponds to a state of profound dementia which precedes death. The
intense hypertemias which accompany or produce the softening appear partly
to determine ^e violent maniacal excitement. Frequently also, when the
mania is of long standing, there is found pigmentation of the cortical grey
substance.

II. Chronic Insanity. — (1.) Cases in which no' anatomical lesion is found
are here rarely observed ; the same may be said of simple hypersemias ;
opacity and thickening of the membranes are common (much more so than
in acute insanity).

(2.) Many cases present lesions which kre lifever observed in the former
dass : namely, atrophy of the brain, particularly of the convolutions ; chronic
hydrocephalus, effusions into the subarachnoid space, pigmentation of the
cortical substance, extended and profotmd sclerosis of the brain.

(3.) Here, softening is not so friequently met with in the superficial
cortical layer as pigmentation, superficial induration and adhesion of the
pia mater ; all in very various degrees.

(4.) In these states, but perhaps also in the acute stages, slight super-
ficial inflammations of the. ventricular walls must necessarily be of frequent
occurrence; the granular condition of the ependyma and the frequent
adhesions of the ventricular surfaces demonstrate this.

(5.) When the disease reaches the chronic stage, hypersemia ceases;
when it does exist, it is of the nature of hypersemia ex vacuo ; sometimes the
more or less atrophied brain is anaemic and (edematous. All the changes in
the brain are less indicative of active processes than of consecutive states
and residues of former processes, and of marasmus — corresponding to the
character of the symptoms observed during life.

(6.) Between partial dementia and dementia there is as little difference,
anatomically, as between melancholia and mania : still, generally speaking,
considerable atrophy of the brain corresponds to a condition of profound
mental weakness. (The reverse, however, does not hold good.)

III. Paralytic Dementia, — (1.) Even here, cases are occasionally met with
where no palpable changes exist appreciable to the naked eye; but these are
rare and of slii^ht significance, as we know that in such cases the microscope
reveab important anatomical changes.

(2.) The changes mOst frequently ^observed in general paralysis are great

?14 Rmmif [Jalyj

(fidemft of the membranes, adhesion of the pia mater to the cerebral surface^
greyish red soflening, or coloration ; and partial, superficial induration of the
cortical substance, with increase of connective tissue and destruction of the
nervous elements.

(3.) Atrophy of the whole brain, or especially of the convolutions, is
very common ; together with its further consequences, induration of the
cerebral substance, dilatation of the ventricles, &c. The increase of cellular
tissue and development of true connective tissue occurs frequently in the
white substance, either generally diffused or limited to certain portions.

(4.) Pachymeningitic processes, meningeal apoplexy, degeneration of the
cerebral arteries, are common.

(5.) The degeneration of the nerve substance, and in particular the
increase of connective tissue with destruction of the nervous elements, may
extend to the spinal cord (Rokitansky, Joffe, Mildner, Gulliver^ ; an im-
portant circumstance in regard to the substance observed during life,

(6.) The anatomical changes in general paralysis are more evident, more
characteristic, and more general than in any other form of insanity : still,
they are not always identical, but constantly present certain varieties. Thi^
appears to depend upon the fact, that in some cases one and in other cases
another element of the disease is the most prominent (it may be meningitis,
or atrophy of the entire brain, or sclerosis of the cortical substance) ; and
this may depend upon the more rapid or more acute course of the disease.

From what has been said, we arrive at the following general conclusions : —

(a.) Insanity, whether acute or chronic, may be the result of simple
abnormal excitation or nutrition of the brain, without the existence of any
palpable change.

{6,) In the majority of cases this is not the case ; it depends upon pal-
pable diseases which are generally distinct in proportion to the duration of
tjhe insanity. These consist partly in hyperscmia and inflammatory processeSi
which, as a rule, are first observed in the pia mater and cortical substance,
penetrate to various depths of the cerebru substance, and, if not arrested,
terminate in incurable destruction and atrophy of the cerebral substance — a
lesion to which the ffroup of symptoms of dementia corresponds.

(c.) Frequently, nowever, it is non-inflammatory changes in nutrition,
recognised only in their final results — viz., marasmus of the brain — which
correspond to the serious secondary forms. The initiatory periods and
stages of development of these nutrient changes, which correspond to the
primary forms as yet are uninvestigated. To these processes we may give
the name of atrophic irrigation of the brain,

{d.) Our knowledge of symptoms is not yet so far advanced as to enable
us to state with certainty whether, in a given case of insanity, anatomical
changes exist, and where they are situated ; but the facts which we observe
enable us to speak with as much confidence as we can in any other disease$i
of the nervous system,

(e.) The most important circumstance in regard to anatomical diagnosis
and to prognosis is the existence or non-existence of severe mo^ory fyorder^,
in particular of general progressive paralysis.

Book V treats of the The Prognosis and Treatment of Men-
tal Disease, Chapter I qn the Prognosis has already appewed ^
a translation in the pages of this Journal for October, 1865.

The remainder of the work is occupied with the TAerapetUics of
Mental Disease. The just relations between the moral and medi-
cal treatment of the insane are thus ably stated : —

1867.] Reviews. 815

It has so come About, from the fact of results arrived at through experi-
ence, that both the psychi<:al and somatic ooethods o f treatment are equally
entitled ^ ^ precisely similar amount of our attention. Both modes of
acting upon the patient have always instinctively been combined, and the
most narrow-minded moralistic theory cannot possibly dispute the efficacy of
properly directed medicaments — baths, &c. ; while, at the same time, every-
iday experience has shown that almost no recovery can be perfected without
psj^ical remedies (which may only cpnsist of work, discipline, &c). In
spite, however, of the practical utility of this method, theoretical hypotheses
liave rendered it difficult for science to recognise the results of experience —
the call for an undelayed combination of mental and physical remedies in
mental disease on the ground of its necessity. Can deviations of the power
of thought, it ^as been inmioally demanded, be corrected by the thinning of
9Xi atrabilious bloo4» or by the solution of stagnant fluids in the portal
system ? Sl^al] mental pain be combated with sneezing-powders, and per-
verted witticisms with clyster- tubes ? The votaries of physical treatment,
on the other hand, urge the influence of the bodily states upon that of the
mind ; they appeal to the cases in which— ay, quite evidently-r-insanity has
he^n eure4 by digitalis, camphor, &c. ; and, as generally happens in such
cases, science, which aims above all things at unity and consistency of prin-
ciple, satisfies in the end both parties, by the eclectic admission that in indi-
vidual t^rgent cases either the one or the other system of therapeutics must
become secondary or assisting treatment to the other or chief plan of treat-
inent. So, wit}i the one party, psychical with the other, somatic treatment
plays, in comparison to the importance of the principal plan of treatment,
pply A subordmate aqd meagre part. But to understand the pecess^y equal
right of both xpethods, it may be ren(iembered, in the firs^ place, that all psy-
chical acts, norn^al Qr abnormal, are cerebral phenomena^ apd that cerebral
fictiyity may be modified quite as effectually, directly, and immediately by
the evocation of frames of mind, emotions, and thoughts, as by diminisning
the quantity of blood within the cranium, or by modifyiing the nutrition of
the brain, as, for example, by narcotics and excitants. The fi^pt that medir-
pines proved empirically to be eflectui^l have been employed in insanity,
fiS in other diseases of the br^in, requires no vindication ; the frequent
iiuccess of psychical treatment, too, in cases where palpable organic lesions
}^d influenced the development of the mental disease, is explalued by the
^fliience whicl^ the brain exerts upon other organic processes: we have,
tiierefore, a very powerfi^l means of successfully modifying indirect disturb-
ances of the somatic state (of the circulation, the digestion, &c.) in the direct
provocation of certsun states of mind. It is true that serious disorganisa-
tions of the brain (as imbecility with paralysis) render (of course) alT moral
influences impossible : but we know that insanity, at its commencement,
consists very frequently of mere functional dernngement, aud that anaton^i-
cal changes, if ^l^h^, do not render the success of moral treatment altogether
impossible, provide^ that the orgs^ns are capable of accommodation to a cer-
tain extent to their respective functions ; and the success which in recent
times h^ attended many attempts, even in idiocy, and where the br9,in was
defective, demonstrates that the skilful use of appropriate means renders
possible a certain development of the understanding. From this point of
view, the treatment of insanity appears to be eminently personal ; it is simul-
taneously directed to the physical and mental nature of the individual, and
when, in the following chapters, we speak in detail of the psychical and
somatic as distinct modes of treatment, the fact of their intimate relation to
one another cannot but be very evident.

Professor Griesinger adds the weight of his great name to those

216 Jieview$, [July,

of M. Morel and Dr. L. Meyer, in defence of the English T^on-
restraint system. " In taking '* he writes '' a retrospect of the argu^
ments for and against, we can easily understand how. the value of
the system of non-restraint was so lo/ig questioned, and. how ih6
arguments against it appeared to keep the ascendancy. But if w^ cour
aider that these objections proceeded entirely froin those who had not
practidaily tested the system of non-restraint, ctnd had never eveii
witnessed it, their force will not appear so great. . If we Interrogate
experience, which is the only proper test, ^t shall find .tl^tt di;|rmg
the last ten years all doubts m reference to it have been r^:iioyedi
The question is now decided entirely in favour ^f non^estrainii
This great reform is now carried out with the mJost favourable res^lti
in every public asylum in England^ and the name qf Conolty will
always be mentioned with that of Pinel, whose work he hofi ^ompletefl*
Lastly, we. shall allow Professor Griesinger to state his. opinions
on the " family-treatmenf of the insane, which he does with his
usual love of truth and clear judgment.

Another plan than that of asjlums has been followed in som^ places fot
the maintenance and employment of the insane. A cqlonv.of insane has
been formed in the remarKable Belgian village of 6heel,in which, for .several
hundreds of years past, lunatics have lived together with the inhabitant^
and even resided in their families.' In former times, people fr^uently
resorted thither to supplicate the aid of Dymphne, the patron saint of the
insane, although people are seldom in the habit now of consulting her oracle.
Repeated attempts have recently been made -to establish some degree of
regularity and system among this settlement of lunatics. Out of a popula*
tion of about 9000, it has from 900 to 1000 inhabitants who are insane. In
the ^ear 1850 it was sought to establish an administration foi* regulating the
habits of the people and to introduce some informs. But accor(Sn;g td
Farigdt,* these attempts generally met with little success. The lunatics
enjoy an amount of pleasure and freedom which never could be permitted
them in an asylum. All who are capable of it share in the mechanical or
agricultural employments of the sane. The treatment in the main is very
mild, and restraint is never made use of without previously consulting a
physician. Suicide is rare, and the general physical health so good, that in
1838 two of the patients reached upwards Of 100 years of ^e. Owing to
the peculiar situation of Gheel, escape by the patients is difficult; it is en-
closed by moors, and is several leagues distant from other villages. With
all its advantages it has undoubted drawbacks, and there has recently been
published such an amount of literature of a polemical kind, furnished by critics
and visitors of Gheel, that although the majority are in favour of this lunatic
colony, they are obliged to admit it has serious defects. But the experiment
at Gheel has provedf that the greater number of insane do not require the
confinement of an asylum'; that many of them can safely be trusted with
more liberty than these institutions allow; and that association in the
family life is very beneficial to many insane patients. The case of Gheel
has suggested the question whether similar colonies might not be established
in other places, and the evils resulting from the overcrowding of lunatic

* * Joum. de M^d. de Bmxelles,' 1859, p. 464.
t Roller, • Ztschr. fiir Psych.,' xv, 1858, p. 420.

1867.] Seviews. in

asylums thereby removed. In England and Germany an exact imitation of
Gneel has been recommended; it was recently proposed to assemble a
number of lunatics within a Tillage in the immediate vicinity of a Govern-
ment asylum, so that it misht maintain a certain relation to them- The dif-
ficulties in the way of adopting this plan, which have been collected and
clearly Mt down by W. Jessen,* have not yet been surmounted. Still, how-
ever, I continue in the belief that the day will come when the means and
method will be discovered . by which the problem of a lunatic colony, and
thus the question of the care and treatment of all classes of the insane will
be finally solved.

With these words of hope Professor Griesinger concludes this
most able work. He is in every sense of the word the represent-
ative man of the modem German school of psychology, and we con-
gratulate the student of mental science in having now placed within
his reach an EngUsh version, by the N^ew Sydenham Society^ of Pro-
fessor Griesinger's invaluable contributions to the study of mental
pathology and therapeutics.

iU Oeorge^s Hospital Reports, Edited by J. W. Ogle, M.D.,
F.E.C.P., and T. Holmes, E.R.C.S. Vol, I, 1866, pp. 427.
London : John Churchill & Sons.

It is with great satisfaction that we have witnessed the adoption by the
staff of several London Hospitals of the plan, inaugurated by the Guy's
Hospital authorities many years since, of collecting and reportmg cases of
interest and rarity, and of promulgating the results of clinical observation
carried out in the wards. For although hospitals have been made to con-
tribute largely to the progress of practical medicine, by furnishing materials
for the lectures and writings of their medical officers, as well as for the
clinical study of their pupils, yet a vast amount of most valuable information
has hitherto lain buried m case and in note-books simply from the absence
of a convenient and satisfactory medium for its publication. The adoption
by several hospitals of the plan of publishing Keports will, moreover, we
believe, add to the benefits smgly accruing from them as records, by fostering
a spirit of emulation between the different institutions in purvey mg for the
edification and instruction of their readers. The profession at large will be
gainers by the more careful editing called forth by the desire to recommend
the Reports to general acceptance, and to make them a success pecuniarily, and
by the esprit'de'Corps which will animate the medical staff of each hospital
engaged in their publication.

St. Greorge's Hospital has now followed the example set originally bv Guy's,
tnd produces a volume of reports, including original memoirs, written by
several of its present medical officers, and by old pupils, most of whom have
acquired a position for themselves in important medical institutions else-
where. It has the advantage of being edited by two experienced and able
literary men. Dr. J. W. Ogle and Mr. Holmes, and gives evidence of the
advantages thence derived. Both editors are also contributors of original
articles. Dr. Ogle treats of disease of the brain as a result of diabetes

• * Deutsche Clinik,' 1858, ' Ztschr. f. Psyoh.,' xvl, p. 42.

did Reviews. [J^7>

ihellitus, illastmting hie femarks by a typical case, 4nd also makii^ good use
of the clinical records of the hospital in collecting notes of fifteen fatal ca8e»
of that disease. His observations compel him to the conclusion that, " what-
ever may be the more usaal relationship between diabetes and disease of the
brain, when they are found to occar in the same patient, there are cases in.
which brain lesion may follow in the train of diabetes and grow out of it,
being in no wise antecedent to, or the cause of it."

Mr. T. Holmes is a larger contributor to the volume, having furnished
three articles of much practical interest. He reports a case of meningocele,
in which iodine was injected without ill consec][uences, and which would
afford justification for again trying a like proceedmg, in a properly selected
case, with the view not of curing but of arresting the progressive increase
of the tumour by growth and over-distension. His second paper b on am-
putation at the hip-joint ; and the remaining one presents a valuable analysis
of the tables of amputation at St. 6eorge*s Hospital, from the year 1852 down
to the present time, with the exception of one consecutive period of twelve
months. This table now comprises above 300 completed cases.

Other members of the staff who have articles in the present volume are.
Dr. Page, Dr. Dickinson, Mr. Prescott Hewett, Mr. George Pollock, and
Mr. B. E. Brodhurst. Dr. Bence Jones writes as " formerly Physician to
the Hospital** ; Dr. William Ogle, as lecturer on physiology in the medical
school ; and Mr. Rouse, as lecturer on anatomy. Other attaches of the
hospitsd and also contributors are. Dr. R. E. Thompson, the medical registrar ;
and Dr. Sturges and Mr. Pick : of the two last-named, the former gives a^
annual report of the cases admitted into the medical wards, the latter, one
of the surgical cases treated during the year 1865.

Dr. Page's paper on the history of St. 6eorse*s Hospital and School
rightly occupies the first place, and is followed by an appendix Containing
the names of all the physicians and surgeons connected with that important
institution since its foundation in 1733. It is altogether an tbrticle of
especial interest to the students of St. Geoi^e's. Dr. Bence Jones writer
well upon jaundice and biliousness ; and Dr. Hewett commenced a proposed
series of " Contributions to the Surgery of the Head ** by a memoir on thd
<^viations of the base of the skull in chronic hydrocephalus. Dr. Thotnpsloil
gives a sketch of the history of the typhus epidemic of 1864-65, as obseired
at the hospital, and Dr, Allbutt, of Leeds, notes the features of an epidemic
of 1865-66. Dr. William Ogle places upon record a large number of orii
ginal researches on the fiuctuations of tetnperature in the healthy bbdy, and
on the conditions whereon they depend, with the view of estabKsning 4
standard for use in carrying out thermometric observations in disease. He
refers to the more numerous and prolonged inquities of Dr. John Davy,
which, though generally accepted as furnishing the i^equisite data, lire, hbW<>
ever, vitiated by many inaccuracies.

We cannot in this brief notice transcribe the titles of the #hole of th<ft
twenty-two papers contained in this valuable volume, and note the partrdiilar
points they serve to elucidate ; we therefore content ourselves by noting
such among them as are more likely to interest the readeirs of a jbtirhal spe-
jcially devoted to the consideration of disorders of the bf'ain and tietres.
jPoremost among such is an essay on the diagnosis, pathology, and treatment
of progressive locomotor ataxy, by Mr. J. Lockhart Clarke, which, from its
value and importance, will claim especial notice elsewhere in this Jouthal.
Another pi^^ " On Cerebral Symptoms occurring in certain Affectifoio^ ^
the £ar,*' wul be read with great though painful intei^^st, as one of thlei lat^rt
cpntribuiiona of Mr. Toynbee, whose premature aild ti^c death tht^ pM-
fession has recently fiad to mourn. Dr. Dickinson naihrdtes dasetf df the
ISrmation of coagula in the cerebral orteries^'mid-foHows ifitbpathologioal
comments thendoD ; 9xA lastly, Dr. Fussril, of Brighton, iumniflnrises briefly

1867.] Report on the Progrm of Psychological Medicine. 21d

the rtoticed of^86tetaI writers oA the subject of paralysis occurring iu child-*
bed.

Our readers will gather from this outline 6f the contents of this volume
how much there is in it calculated to advance the knowledge of medical and
surgical pathology, and to place treatment on a safer basis than it has hitherto
acquired. We trust the editors will be encouraged in continuing the work
year by year, for we consider that such hospital reports are among the most
valuable additions to the library of the working medical man.

*' '■■ ■ — ■■■ — — 1 t ■

PART lll.-QUARTERLY RepORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.

I. Italian Psychological Literature.
By J. T. Aeudgb, M.B. atid A.B. Lond., M.H.C.P. Lond,, kc.

Two years hare glided by since we last placed before our readers
an abstract of the labours of our Italian fellow- workers in the field
of medical psychology, and, as may well be supposed, therefore, we
find ourselyes overmatched by the accumulation of Italian papers
requiring notice, for some of which, consequently, no space for aught
than Hieir titles can be found within the allotted extent of this article.
Indeed, the periodical medical press of America, France, and Ger-
many is so prolific that it is next to impossible to keep our readers
wu courant with its productions. The present limits of the ' Journal
of Mental Science,' its quarterly publication, and the demands upon
its pages for the coni^butions of British psychologists, for reviews
for the report of the annual meeting, and for other matters im-
peratively demanding room, compel the abridgment of the quarterly
abstracts, and now and then their omission altogether.

The ' Archivio Italiano per le Malattie Nervose e per le Aliena-
rioni Mentali' continues to oe regularly published bi-lnonthly under
the direction of the same able editors, Drs. Yerga, Castiglioni, and
BifiS. In the six numbers for 1865 we meet with the following
^ri^tud cotumunications :^-on genius and madness, by Borrikci;
0!i legislative reform for the insane and for asylums> by Gastiglioni ;
on psendochromestesia, by Berti j on the phrenic nerve and it« rela^
tions to asthma, by Panizza ; on severe melancholia terminated by
erysipelas ; on the genera and species of insanity from a patholo-
gical point of vkw, hy Carlo Livi; on the sulpho^cyanide of potas-
sium IB its relations with the saliva in hydrophobia, &o., by Lus-
Mna; a singular case of neurosis, by Berarduod; on a ne# i&ode
of deifvlopment of cateaieoils concretions within the dratiiuiki, by
BifetMero; a medico-legal report on a case of.wife^murder, by Bm-

220 Eeport on tie Proffresa [J^7i

fanti and Zuffi ; on bromide of potassium in nervous disorders^ by
Liberali^ and by Biffi and Salerio ; a notice of the old and of the
new Sienna Asylum^ by Carlo Livi ; on the disordered respiratory

Shenomena of asthma^ by Perosino ; on the classification of mental
isorders^ and on their treatment by the Erythroxylon coca^ by
Mantegazza; and lastly^ a medico-legal report on an incendiary, by
Bonafanti and Valsuani.

Several of the papers whose titles are given above have been
spread over two or more numbers of the Journal, whilst others are
brief letters directed to the editors. Polite and complimentary ex-
pressions towards the editors and others referred to lorm evidently
an important ingredient in the communications of Italian physicians,
though it is one which would be indifferently appreciated in an
EngUsh journal, particularly if as liberally employed as we find it
in the 'Archivio' under notice, at the cost of print, and at the
sacrifice of the time and patience of the student who wants to
quickly seize on the gist of the article.

Abstracts from home and foreign journals occupy an important

J>osition in the Italian archives, which further comprise more or
ewer bibliographical notices of new books, together with memo-
randa of passing events, of asylum reports and changes, of medico-
legal decisions, and of personal incidents amongst the psychologists
of Italy and other countries.

Dr. Borrucci's communication is in the form of a letter, wherein
he contends against Moreau de Tours' inferences respecting the
close alliance of genius and madness, and the nature of the former
as a neurosis. The conclusion that genius and insanity are so
nearly akin rests on the record of the peculiarities of character and
of the moral obliquities of men of note; but, as Borrucci points
out, it is not a just inference that such irregularities are peculiar to
such men, the fact being that, by reason of the genius they display
and the prominent position they occupy in the eyes of their fellow-
men, attention is directed to the details of their life, and incon-
sistencies and oddities are noted which in common-place characters
would be overlooked.

Lunacy reform. — Castiglioni writes to Gualandi (of Borne) to
advocate the reform of the lunacy laws and of the system of asylum
administration. He would have the question of the existence of
insanitjr definitely settled in cases coming before the tribunals, by
trained and experienced psychiatrists ; and he urges the propriety of
consulting such specialists in all attempts at legislation for lunatics
and asylums. He rightly objects to the propositions of Gualandi,
that there should be in asylums a separate fiscal authority in the in-
terests of the patients, and an independent ecclesiastical surveillance;
ai^^g that such a multiplication of authorities would be destructive

1867.] of Psychological Medicine, 221

of harmony, of order and of effectual discipline and management.
The inmates of an asylum are presumably placed there with a view
to their recovery ; the treatment to be followed to attain this end is
the business of the physician, and the entire economy and super-
vision must be subordinated to him.

Castiglioni urges the adoption of the following propositions : — 1.
The institution of a board of inspectors, subject to the Home
Minister. 2. The establishment of sufficient public asylums to
accommodate the pauper insane, and at the same time to receive
paying patients ; the institution of private asylums for the richer
classes, and the recognition of the plan of boarding out-patients,
both paying and pauper, in private houses. 3. Both public and
private asylums with respect to their construction, their internal
government, and their arrangements, should be subject to appro-
priate rules. Moreover, all patients resident in their own homes,
or in the houses of private persons, should have their condition
regulated by arrangements made by the inspectors and approved by
the Home Minister. 4. One at least of the inspectors should be a
)hysician specially conversant with insanity, to whom the surveil-
ance of all asylums and of individual lunatics should be delegated.
5. A special enactment should define the powers, duties, and emolu-
ments of the inspectors.

A medical man should be invested with the charge of any patients
resident in private families, and be at the same time responsible to
the authority ^'of public security,^' to which he should send all
necessary notices. If the medical man should deem such patients
not sufficiently secured against injury to themselves, or against
pubUc scandal, or against danger or loss to the public, he should
report it to the public authority. In case of recovery, of death, or
of escape, or of resignation of his charge, he should do the same.
In the last-named contingency the office of " public security" should
appoint a successor. Nevertheless, a medical man's attendance
niight be dispensed with where the patient is harmless and not in
need of medical aid, provided that some responsible person was
^trusted with the supervision of the case, in conjunction with the
board of ''public security .^^

Application for admission should be made to the medical director
of the asylum, and, only under exceptional circumstances, attested
oy two persons, should a patient be received without formal appli-
cation from the parents or guardians of the lunatic, or from the
public authorities. A certificate of lunacy from a medical man is
^ requisite, which, together with the other documents required
for admission, and his own report on the case, should be transmitted
oy the medical superintendent to the office of '' public security.'*
■Patients may be removed from an asylum at any time after admis-
sion by those who have placed them there, except in the case of

VOL. XIII. 16

2£i Report on the Progress [July,

patients transferred from a hospital, for whose discharge the avtho*-
rity of their relatives is necessary. The transfer of patie&ts to pri-
vate houses, or to asylums out of the country, requires the authority
of the board of "public security/' The medical superintends
may discharge patients on their recovery, and dso by way of trial,
when persuaded that their being set at large does not jeopardise the
interests and safety of others or of the patients themselves. At the
same time, the superintendent is bound to inform the friends of the
patients who have placed them in the a^lum, and also the pubHe
authorities.

The opening of private asylums should be smbjeeted to the
approval of the public authorities, and their administration r^ulated
according to law. Both public and private asylums to be under
the supervision of a board appointed for the province where they
are found, and to be governed according to rules approved by the
lunacy inspectors.

The entire medical and disciplinary government of every asylum,
but not its internal administration, to be placed in the hands of a
medical superintendent. The relations between the medical sup^-
intendent and the managing committee to be determined by this
committee, subject to the approval of the lunacy inspectors and
of the minister of state. Besides the superintendent, there should
be at least one other resident medical officer ; and when thefe are
more than 80 inmates, another such officer is required; and iA
general, there should be one medical officer to every 100 hmaticH
in an asylum. In such institutions, moreover, of importance, tiid
superintendent should have an assistant medical officer, to serve as
secretary and to assume his functions when absent ; and in those
establishments of still greater magnitude, there should be a well-
educated microscopist possessed of ample histological and cheaddd
knowledge. Where no assistant or secretary to the superint^d^t
is found, the duties of such officer should be undertak^i by the
senior resident medical officer.

Such is a brief analysis of the leading propositions of Castiglicoa,;
which in general resemble the regulations in force in English and
in many foreign asylums. The author of the scheme introduces
many others, such as the complete separation of the sexes, which
appear as a matter of course. One of the propositions wherein he
departs most widely from English precedents is that fixing the
number of medical officers for asylums. The proportion assigned
relatively to the number of patients is calculated to arouse the
amazement of a Middlesex magistrate, and frighten him into a
convuhsive seizure. And well is it that the proposition proceeds
from an unenlightened foreigner who has not learnt the capacity
ef English medical superintendents, and the views of Yiiitiag
Jnstiees concerning l^ir position and purpose in asylums.

1867.] of Psychological Medicine. 223

PseudocAromeitesia, the subject of a letter by Dr. Berti to Dr.
Veiga, will be a new phenomenoD — at least, in name — ^to our
readers. It indicates (says Berti) a new disease, and the first
notice of it appeared in the * Gazette M^dicale de Lyon/ The literal
meaning of the term is, "false sensation of colour/^ but Berti
defines it as expressive of an altered visual perception (not due,
however, to optical disturbance in the eye itself), whereby the
objective and subjective perception of any numeral, or of any letter
of the alphabet, or of combinations of letters or figures, is neces-
sarily and inevitably connected in the mind with an impression of
colour peculiar to each of them. The patient does not see them
otherwise than black, the colour in which they are printed, but the
perception of them in the mind, and the recalling them to memory,
is associated with certain hues. Thus, Dr. Chabalier, who has
described a case, states that the patient always found a of a black
colour, ^ of a grey, i of a red, and ^ of a white tint ; whilst, with
respect to numerals, 5 and all its multiples assumed a vermilion
colour, 7 a green, and 9 a black one ; again, with respect to letters
in combination, the word Sunday presented a white colour, Wed-
nesday a pale red, and Saturday a oright red one. As a psychical
phenomenon, moreover, each such word, when recalled to memory,
vas associated with its relative colour.

Dr. Berti proceeds to inquire into the nature of this curious
phenomenon. It is in no way connected with any change in the
stracture of the eye ; it is not due to congestive amblyopia ; it is
quite distinct from daltonism and from astigmatism. On the other
hand, it is a psychical phenomenon, though not a hallucination.
It consists, in Dr. Berti's opinion, in an accidental and not necessary,
though persistent, association of ideas, whereby each letter and each
igore evokes the notion of a colour, in a manner not unUke the
r^ts of some ingenious mnemonical devices wherein certain signs
or numbers are employed to bring to remembrance, by way of mental
associftion, dates, or names of individuals, or facts in science; or,
byway of further illustration, just as certain words, or actions, or
impressions, are associated in the minds of every individual with
^ents of early life, and recall them unbidden to the mind, though
the chain of connection between the two be entirely lost sight of.

Anatomy and Plynohgif of the Phrenic Nerve, — Professor P^zza
has studied these questions experimentally on several of the lower
animals, and has arrived at the following results : — 1. The phrenic
Bearves arise by two or three roots, and although essentially motor
in fimctions, yet possess some sensitive fibres ; 2. In their course
through the thorax, they neith^ give off nor receive nerve branchesi ;
S* On reaching the diaphragiji, each nerve divides into fVom thre^e
to five branches, which ramify in the fleshy portion of thjit septum,

224 Report on the Progress [Jtdjr,

and particukrly in the vicinity of the vertebral column— the nerve
of the left side, however, not inosculating with that of the right ;
4. The left phrenic does not unite with the oesophageal branches of
the vagus nerve ; 5. The phrenic nerves supply no branches to the
stomach, spleen, or liver; 6. The attachments of the diaphragm to
the ribs receive fibres from the phrenic nerves and from the
diaphragmatic plexus of the intercostal nerves.

Section of the phrenic nerves paralyses the diaphragm, and is
followed by disordered gastric function; not, however, from the loss
of nerve supply, for the phrenics give none to the stomach, but in all
probability, from the suspension of the mechanical action of the
diaphragm upon the stomach.

Melancholia^ terminated hy Erysipelas. — ^The case in question is
one of many placed on record where an acute malady, such as
erysipelas, has been followed by recovery from long-standing mental
disease. The patient had an attack of delirium in 1859, and after
three months^ treatment was discharged from the hospital cured.
Soon afterwards, however, a relapse occurred, and he was readmitted
into the general hospital at Milan, where, after the Lombardic
fashion still in vogue in nearly all maladies, he was treated anti-
phlogistically — which means, was well bled. But as his madness
could not be withdrawn from his veins, he was (after four months'
attempt at curing him) sent into the Senavra Asylum in December,
1860; whence he was retransferred, in February, 1861, from want
of room, to the general hospital. During all this period he was
in a melancholic state, with suicidal tendency, — stupid and taciturn,
avoiding the society of others, and constantly complaining and
fretting. In March erysipelas supervened spontaneously, and spread
over the head, neck, and trunk, lasting forty days, and jeopardising
his life. However, as convalescence set in, the mental syniptoms
vanished, and after a further residence of three months for trial and
observation, he was discharged well. ^

Pathology of Insanity, — ^Dr, Carlo Livi continues, from the first
volume, his papers on this subject in relation to the varieties of
mental disorder; but as they constitute a general dissertation o
the causes and diagnosis of insanity, and on the evidences of th^
disorder in a medico-legal point of view, they admit of no osefii- -
analysis for these pages, though they may be perused wittai
advantage.

Dr. Lussana also continues to narrate his experiments and con^
elusions respecting the saliva^ the poison of hydrophobia^ and i
Wborara poison. His latter papers being specially occupied with
examination of the last-named poison, consequently rather comme:
themselves to physiological students than to psychiatrists.

1867.] of Psychological Medicvne. 225

A singular case of Neurosis, by Dr. Carlo Berarducci. — ^The case
narrated under this heading is that of a woman, a native of Perugia,
who suffered with somnambulism from the age of fifteen. Her
fefcher died insane ; her mother was living, but nad ovarian dropsy,
and she had two brothers alive and in health, although one in his
youth exhibited much extravagance of character. When five years
old she nearly perished from smallpox, but afterwards grew stronger
and enjoyed faur health, being subject, however, to headache, and
of a melanchohc disposition. At seven she was placed in a con-
ventual school ; when eight, and again when twelve years old, she
had a severe fall on the head, and on one occasion was rendered
insensible for a considerable time. At twelve menstruation was
estabhshed, but not long after was suppressed by a fright she
received, and did not reappear until her nineteenth year. It again
ceased, and did not recur until she was twenty-two ; after which it
Was regular, but very deficient and painful. At the age of fifteen
somnambulism commenced ; she wandered at night and could not
find her way back to her bed in the dormitory without the guidance
of others. A lamp burned in the apartment, but she was quite
oneonscious of its light, although she could make her way to a
particular window, having a well below it, and through which she
made attempts to get. She frequently called the doorkeeper to her,
whom she would severely scold, although in her waking state she
held this person in much fear and respect. At eighteen she was
removed from the school and entered on service as a housemaid,
the somnambulism still continuing for six or seven months. At
length her mistress had her to sleep with her, when the morbid
state gradually declined. For three years she remained better, the
attacks being very few, and now for fourteen years she has had
no return.

During her residence in the school she was melancholic, fond of
soUtude, excessively devoted to religious asceticism, and exhibited
a strong erotic tendency — she also became the victim of a certain
degree of demonomania. When twenty-two years of age she became
desperately in love with a young man, but would not marry him.
Xhree years subsequently she had typhoid fever, recovered slowly,
and afterwards exhibited great deterioration both in her mental and
physical condition, and on two occasions attempted suicide. There
Was much general debility, with gastric pain and indigestion. Her
headache was severe and almost constant, obliging her to remain in
bed for two or three days together. The most intense pain was in
the occipital region and vertebral column, and was accompanied by
constriction and weight, especially in the lower extremities, which
were nearly always cold. There was a tendency to syncope, some
dyspnoea at times, and uterine pains, aggravated during menstruation,
with leucorrhoea and globus hystericus. Her nights were very resti

3i26 Repori on the Progress [J^ly*

less ; her sleep disturbed by frightful visions^ the best temedy for
which was the presence of a light in her room. Her Nmcm. was
weak^ and she had frequently hallucinations of sights of hearing,
and of smell. Her memory was very infirm, particularly witk
regard to recent events ; whilst her usual melancholia and quiettuk
were replaced at the menstrual period by agitation, sometimes
amounting to actual mania, and attended by ill-feeling toirards, anil
a propensity to injure her mother, and also by general contrariety
of manner and perverseness. At times, this transition of one form (rf
mental disorder to another was varied by the inta^ention erf a short
period of hilarity, with passing fancies of being of gigantic, or otherwise
of dwarfish dimensions. After the first few years of her residenoe ia
the conventual school, and when she was in the habit of pass^
much time in solitude, her mind would involuntarily engage itsetf
in numbering objects in sight, running on, doubling and trebhng
with surprising rapidity. This mental labour soon afterwards wis
not hmited to periods of seclusion, but was carried on when in
company with others, and when engaged with work, continuing
unchecked by the will or by diversion tx) other matters until
darkness rendered objects around her no longer visible, lids
ungovernable propensity to count everything around her w»s the
most remarkable feature in the case, which in other respects
presented no very unusual symptoms, although a good example erf
somnambuUsm.

On a New Mode of Development of Calcareous Concretions mtJUn
the Cranial Cavity is the subject of a paper by Dr. Giulio Bizzozero.
Such concretions occur in the pineal gland, in the pia mater, dure
mater, and arachnoid, in the Pacchionian corpuscles, and in the
walls of the ventricles. They fracture readily, are of a round or
irregular figure, refract Ught strongly, and are enclosed by a coating
of connective tissue separable into several lamina. Their mode of
origin is disputed, and probably varies in the different tissues in
which they are found. Bizzozero examined them with the view of
elucidating this matter in a small tumour growing from the dura
mater of a man who died from tubercular disease of the lungs and
intestines, but who had no head symptoms. The tumour grew
from the inner surface of the dura mater, to the left of the longi-
tudinal sinus and in the frontal region, and had deeply pressed
itself into the subjacent grey lamina. It had a granular surface^ a
reddish colour, was rather hard and gritty when cut into, uid
slightly infiltrated with a reddish-white fluid. Viewed micro-
scopically, it presented the usual characters of a sarcomatous growth^
containing connective fibres and an immense number of fusiform
cells enclosing an elongated nucleus with nudeoli. Acetic add,
as usual, converted the fibres and cell matters into a homogetneou^

J867.] of Psychological Medicine. 2,2,7

mas, leaying, however^ the nuclei unohanged and apparently dispersed
iiregolarlj.

Interspersed among the fibres and cells were very numerous con-
cretions^ of two sorts^ but all strongly refracting. One form had an
dongated^ fusiform shape^ a white^ or yellowish-white colour^ and
were translucent. When treated with sulphuric or acetic acid, with
iodine, or with iodine and sulphuric acid together, they remained
unchanged, and may in all probability be referred to the class of
colloid corpuscles. The other variety had a spherical figure, some-
times rather elongated, strongly refracted light, and were brittle in
eonsiatence. On adding sulphuric acid they were resolved into a
mafis of acicular crystals of sulphate of lime, evolving in the process
some bubbles of gas. In composition they evidently consisted of
aome carbonate, with much phosphate of lime.

An examination of these calcareous particles in different portions
(rf the tumour showed that they might arise either directly from the
componait tissue, or by degeneration of the colloid bodies. In the
former case they appeared first in the form of hollow utricles or
cells, consisting of an enclosing membrane, with limpid contents
and numerous oval nuclei, disposed with a certain degree of regu-
larity among them. These utricles would seem to be generated by a
fusion of several connective-tissue cells, and the calcareous matter
to be deposited in a granular form, following the direction of the
eccentric strise visible on the membranous wall. An irregular,
spherical, calcareous mass soon shows itself, which enlarges by
accretion on its outer surface, and at length transforms the whole
utricle into a calcareous corpuscle, invested with several apparent
layers of transparent organic (connective) tissue, through which the
original nuclei are scattered, but now reduced in size, homogeneous
and indistinct. In concretions of the largest dimensions the nuclei
are, moreover, indistinguishable.

In the second mode of formation the calcareous corpuscles arise
from the colloid concretions which make their appearance in utricles
similar in all respects to those just spoken of, but instead of cal-
careous granules being precipitated within the utricles, a colloid
mass is developed which grows principally in one direction, and
hence gives rise to an elongated or clavate substance, which by and by
imdei^oes calcareous degeneration ; this process commencing at one
extremity of the colloid mass and progressing towards the other
until a complete transformation is effected. The change is marked
hj increased refraction, and even after all the colloid matter is
-superseded the calcareous corpuscles augment by extrinsic growth,
and tend to assume a more globular figure. At length a calcareous
body is produced, resembling in all respects the corpuscles derived
by the other process of development, and indistinguishable from

228 Report on the Progress [J^lyi*

On Madness and Genius. — ^This subject is treated of in a letter
from Dr. Lombroso to Professor Borrucci, written in reply to some
remarks made by the latter in a notice of an essay written by him..
Lombroso therein defends his proposition that genius, though not
mental disorder, yet is excessive or hyper-development of the cere*
bral activity and sensibility ; that it is attended by certain physical
phenomena, and is compensated for by defects in organic activity of
other kinds, and in the sensibility itself in other directions. That
consequently a coincidence frequently obtains between genius and
insanity. (See p. 220.)

To substantiate this opinion, Lombroso quotes the names of
numerous individuals eminent in science and art who have exhibited
more or less aberration of mind. However, the matter discussed
is one of a group of questions the decision respecting which is pro-
bably unattainable, inasmuch as disputants are not likely to agree in
their definitions of genius and insanity, nor are facts and figures
to be found showing how numerous the possessors of genius are
and have been, and how largely insanity has prevailed among them.
We can assign little value in deciding the question to the lists of
names of writers and artists brought forward in illustration of the
prevalence of insanity among those classes ; for whilst some of them
enjoy a world-wide reputation, others possess a very mediocre one,
and not a few owe the remembrance of their name by posterity to
conditions and circumstances aUen to the possession of genius.

Report on a case of Wife-murder. By Drs. Tacchini, Bonfanti,
and Zuffl. — ^The culprit committed the crime by means of a saddler's
awl, which he mounted in a handle and got ready four days pre-
viously. This instrument he drove by repeated blows of his hand
into the skull of his wife, and so firmly did he drive it that it could
not be withdrawn by hand, but required pincers to effect it. The
victim died three days afterwards, having miscarried with a dead
child, about six months old, a few hours previously. The awl was
found after death to have pierced the left parietal bone anteriorly
to the parietal prominence, and to have penetrated fifteen millimetres
into the cerebral substance. After the murder the husband (Zuc-
can) walked slowly away from his home, affecting indifference, but
when followed he made his escape across country and was not taken
till he had got some distance away. To the soldier who captured
him he protested the desperation of his mind, and asserted that he
made the attack on his wife in order to punish her for her dissolute-
ness and her bad conduct towards her children. The evidence, how-
ever, adduced in the course of inquiry instituted showed that the
wife was, on the contrary, a well-brought-up industrious woman,
steady and careful in her house and affectionate towards her children,
and that ever since her marriage, a period of some six years,

1867.] of Psychological Medicine. 229

her husband had maltreated her, had on several occasions beaten
her and driven her from her home.

The man was twenty years older than his wife, and had a robust
constitution, free from hereditary taint of insanity. Two dehcate
children had been bom to him, the younger deformed and very
scrofulous. All the witnesses concurred in representing him as a
vagabond, given to quarrel and to wild jealousy, and cruel by
nature. Pour or five days after his marriage, in a fit of jealousy
without grounds, he knocked his wife down in the street, and obhged
her to take refuge in the house of a neighbour for the night. The
same evil passion operated with him continually, and led him to
repeated acts of violence, threats, and unkindness, so that the unfor-
tunate wife had a foreboding that some day she should fall a victim
to him. The plea of insanity was set up in his defence, and the
reporters carefully examined the culprit. In the plea it was stated
that he had at times been called crazy and mad, but the reporters
assigned no importance to these appellations, inasmuch as they were
employed without any definite meaning, and could only possess value
if found in accordance with the mental condition as otherwise ascer-
tained. In their repeated and prolonged interviews with the accused,
they observed no indications of mental aberration. His ideas were
correct and his conversation free and coherent. He refuted the
Sports against his character as calumnies, and exhibited especial
animosity towards the priests of his native village. When examined
relative to his motive for the crime, he denied his first statement
^nd confession as put upon record, and attributed their existence to
the malevolence of the judge. He referred to the murderous act as
Consequent on excessive passion leading to desperation and to ^* a
fatality of circumstances and accidents^^ which as it were fortuitously
ended in the involuntary murder of his wife. This introduction of
Xiew elements into his account of the transaction and the ignoring
of his first explanation are circumstances of moment in forming a
judgment respecting his sanity ; they are indeed unlike the proceed-
ings of an insane person. The intelligence naturally possessed by
Zuccari was sufiicient to appreciate and direct all his actions, and he
himself resented any doubt as to his mental integrity. He was free
from sensorial hallucinations and manifested no delirium. There
was no history of alcoholism, of heart or of brain disease, whilst the
premeditation of the act and the concurrent circumstances excluded
the hypothesis of partial or limited mania, as well as of simple and
absolute monomania. Unfounded jealousy was evidently the im-
pelling cause, but excessive emotion, or passion, the reporters cannot
accept as tantamount to insanity or identical with it.

Tnree conclusions were put before the Court in reply to the ques-
tions submitted : viz. That Zuccari was not (at the date of the murder)
and is not now insane. That he was in all probability incited to the

230 Report on the Progress [Juljj

murder by malice and by the domination of the passion of jealousy.
That the influence of this passion^ which rightly he ought to have
resisted^ may^ nevertheless^ be allowed iu mitigation of his punish-
ment. The result of this report was that he was sentenced to death
for the murder.

On the Use of Bromide of Potassium and Bromide of Quinine in
Nervous Diseases is the subject-matter of a letter from Dr. Liberali
to Dr. Biffi. The writer first quotes the conclusions of Dr. Gubler,
physician of the Beaujon Hospital^ relative to the effects and uses
of the medicine^ and then refers to his own experiments with it.
He used it successfully in 8-grain doses three times a day^ in the
case of a boy^ set. 13^ passing into puberty^ who had just before had
two epileptic seizures and suffered from much vascular erethism.
The medicine was continued for three months^ and during ten
months no return of the fits had occurred. He had also employed
it in various forms of mental disorder, particularly where there has
been sexual excitement and masturbation — administering 16 grains
daily. He tried it in two cases of recurrent mania, but without any
decided effect, and places on record the results arrived at by Dr.
Salerio, physician of the Asylum of St. Servolo, Venice. This
gentleman employed bromide of quinine in numerous chronic and
confirmed cases in the asylum^ during a period of eight months.
Among these cases were eighteen of epilepsy, eighteen of mania
with excitement, delirium, total disorder of the intellect and
diminished sensibility, &c., and fourteen of intermittent mania.
Among the epileptics he could point to little good effected. In six
cases no result followed; in four others the attacks became less
frequent ; in five the intensity of the convulsions was lessened, the
hearths action was rendered less tumultuous, the subsequent maniacal
paroxysms were less protracted ; but withal the frequency of the fits
continued unabated. Lastly, in three other cases, a three months'
interval had elapsed without recurrence of convulsions. Of eighteen
cases of mania, in two he had not courage to persevere with the
remedy, as they seemed to grow worse; in six the excitation
diminished in a few days, and was replaced by tranquil mania with
hallucinations; in four others excitement rapidly subsided, but
reappeared after eight days, but on the repetition of the medicine
recovery ensued, and after three months they were in a state to be
discharged ; in other three cases, under the persevering use of the
drug, the malady, which had been continued, became intermittent,
and the disease progressively declined, and the patients had continued
free from it for two months ; lastly, in the three remaining instances
the excitement ceased, but they continued dull and heavy.

In the case of the fourteen sufferers with intermitt^it mania, the
bromide was administered every e^hth day in 12-grain tloses; four

1867.] of PsffokolQffieal Medicine. iSl

•

of them recovered^ or^ at least, contiiiued without a relapse for four
months ; six had a recurrent attack at the end of three months^ and
on the medicine being resumed, had continued well for one month ;
so that only one accession occurred in five months, whereas, of old,
one happened monthly; moreover, the accession was mild and
lasted oiUy from one to three days. In two patients the medicine
did no good.

Two of the patients suffering with intermittent mania were
attacked with erysipelas of the whole head and of the left side.
During the course of this malady, for fourteen days, these patients
were rational and calm, yet no sooner was the erysipelas cured than
the mania reappeared. The bromide was now resumed, and soon
quietude was regained ; and in the case of one of them, along with
tke reason, whilst the other has remained somewhat heavy and
demented.

In intermittent and coutinued mania bromide of quinine alone
was used ; but in cases of epilepsy this medicine was given alter-
nately with bromide of potassium, with iron, &c.

The general result attained by the bromides may be stated to be,
a calming of the circulatory and of the nervous system.

Borrucci replies to Lombroso by letter on the disputed relations
between genius and madness. We shall, however, not recur to this
weU-worn dispute, one in the main confined to words.

On the Old and the New Asylum of St, Nicholas of Sienna. By
Ca£LO Livi. — It seems that Dr. Cardona, of the Bologna Asylum,
in an account of his visits to various asylums, erred in several parti-
culars in his notice of the Sienna Institution. Hence Livi under-
takes to correct him, and takes the opportunity to describe the
general construction of the new asylum about to be erected. It is
tatisfactory to learn from his communication that many reforms have
been carried out in the old building, new rules framed, and above
all, the physician constituted the medical superintendent, with entire
control both of the treatment of the patients and of the discipline
of the establishment.

The new asylum is to contain 400 inmates; viz. 200 of each sex.
Five classes will be constituted: viz. 1. Tranquil. 2. Epileptic.
3. Idiots and paralytics of dirty habits. 4. Violent and noisy
patients. 5. Pensioners. These last it is proposed to place for the
most part in small detached ornamental villas or cottages scattered
through the grounds. The site chosen is at one end of the city, and
has buildings abutting on two sides. On the other two, however,
there is ample space. The buildings are arranged in a sort of
crescent, of five rectilinear segments — a disposition of parts enforced
by the limits of the site. The central block is occupied by the
chapd, and on either side of it are the servants' rooms, baths, and

232 Report on the Progrese [July^

other offices. The entire building is of three stories, its elevation
is in the Italian style of architecture, and its centre is surmounted
by a dome. It is estimated to cost 500,000 francs (£20,000).
An engraving of the elevation and one of the ground-plan are
appended to this account. The latter shows a great agglomeration
of apartments in the central block, and running the whole length of
the pentagonal front is a corridor with rooms on both sides. Prom
the two angles of junction of the several front blocks of building
and from each extremity, rooms with corridors radiate backwards and
join on to five posterior blocks, having a corridor on only one (the
inner) aspect. By this arrangement five small, enclosed courts are
formed, of little use to the inmates, and partaking of all the serious
objections to which such courts are open.

An examination of the ground-plan, indeed, displays a wide de-
parture from thft models usually followed at this present day in
asylum construction, and a repetition of many of the errors in struc-
tural arrangements so long condemned in most of the continental
asylums, which frequently are ancient monastic structures adapted
to their novel purpose, or otherwise are copies, more or less modified,
from such institutions. The Sienna asylum, therefore, will not
represent the modern views of the requirements and structural
arrangements which we might have desired to find adopted.

On the Classification of Mental Disorders and on their treatment
by Coca (Erythioxylon coca). By Professor Mantegazza. This
is a long dissertation, well put together, but rather verbose and
not redundant in originality, at least as far as the classification
and description of mental disorders are concerned. On the other
hand, the treatment of these maladies by coca is novel, at least to
us Englishmen. The author insists on the necessity for early treat-
ment, and desires to discover the first symptoms of mental disorder
and to decide on the means necessary to relieve them. After sundry
prefatory remarks on these topics the author inquires what insanity
is, and propounds a new definition of it, not however as better, he
says, than others already in existence. It is this : '^ mental aliena-
tion is a permanent aberration of one or of several faculties of the
intellect (intelligence) or of the emotions (sentiments), which cannot
be corrected by the wiU and is almost always unrecognised by the
consciousness (conscience).'' The several propositions included in
this definition he next attempts to sustain by argument. The per-
manency of aberration as a phenomenon of insanity he insists upon
because temporary aberrations are common in health, especially as a
result of various ingesta. He argues further that, as such disorder
may be excited and pass away, so we may assume insanity to occur
without cerebral lesion; and that the lesions met with are not the
causes but the consequences of the essential and necessary patho-

1867.] of Psychological Medicine. £83

genetic cause* Again, he says the essential pathognomonic cha-
racter of madness is the inability of the will to correct the intellectual
disturbance* The defect of consciousness is almost constant, for the
recognition of his actual condition by the patient does not obtain,
save at the commencement of his malady and on the occurrence of
convalescence. The lunatic is incapable of analysing his condition,
and of comparing his disordered with his previous healthy state.
The classification of mental disorders may be based either on patho-
logical anatomy, or on the physiology of the cerebral functions.
The present state of science forbids it on the former basis, but
it may be more or less perfectly founded on the latter. The writer
accordingly resorts to this basis, and in so doing divides mental dis-
orders into several families, to wit : 1, alienation with dementia :
2, maniacal; 3, melancholic; 4, with hallucinations. These fami-
lies he subdivides into genera. Thus alienation with dementia is
firstly separable into two tribes, a congenital, b acquired. Tribe a
has two genera, cretinism and idiocy. Tribe b has three genera :
1, senile dementia; 2, dementia from unknown causes or spontaneous
dementia; 3, paralytic dementia.

Family 2. — ^Maniacal alienation — excessive violence of the will
impelled by irresistible instincts. Genus I. Mania, which is of as
many varieties as there are instincts and feelings (sentiments) ; e. g,
religious, erotic, homicidal, incendiary, &c. Genus II. Polymania,
vague or chaotic mania. Family 3. — Alienation with sadness, con-
stituted by one genus melancholia. Family 4. — Alienation with
hallucination. Genus I. Hallucinations of the senses. Genus II.
Hallucinations of the consciousness (sens intime).

The next chapter is devoted to the consideration of the first
symptoms of insanity, and in framing a diagnosis he puts forward as
a first principle that the gravity of the mental disorder must never
be measured by the amount of intellectual aberration. The charac-
teristic trait of madness is the disproportion between the effect and
the cause. In estimating the value of an assigned cause, the in-
stinctive tendency of friends and relatives to exaggerate it, and
generally to discover a cause when none is present, must not be
overlooked; at the same time it must always be the physician's
endeavour to arrive at the cause in order that he may be enabled to
follow up in their natural order the different phenomena presented
by the case, through their many variations and combinations. We
shall not follow the author through those pages of his essay occupied
with the symptomatology of the several principal forms of insanity,
but will pass on to his chapter headed, '^ Of the philosophical bases
of treatment, &c/' He commences by a critique on the absence of
definite, rational ends in the prevailing mode of treating insanity,
and he foUows by enunciating fourteen leading principles to be
borne in mind. This done he enters upon a discussion of the treat-

284 Report on the Progress [July,

ment to be pursued in the several principal varieties of madness.
In the treatment of idiots and cretins, he would try, as subordinate
however to hygienic and moral influences, stimulants^ such as coffee
and opium, administering them from infancy with a view to arouse
intellectual activity. But he admits, with justice, that little could
be hoped for from these agents.

In the case of imbecile and demented patients he would also use
medicines. In acute dementia following mania he would commence
with hydropathy and finish with revulsives, such as the actual
cautery to the back of the neck, frictions of tartar emetic on the
scalp, setons and the actual cautery. In senile dementia he has
faith only in erythroxylon coca, given to chew in one to two drachm
doses per day, or in infusion after each meal. The leaves of the
plant are much more active, in doses of six drachms or an ounce,
acting much like opium or Indian hemp, increasing the rate of cir-
culation and producing pleasurable hallucinations. His account of
the potent and remarkable properties of this plant is derived from
personal observation and experiment in Peru and other countries of
South America, where it is resorted to as a stimulant and narcotic
by the natives. By its agency he anticipates the reparation of the
nutritive forces in dementia, the diminution of the waste of oi^anic
tissue, and the stimulation of the brain to augmented activity. But
he does not confine his medical treatment to the administration of
this one drug. He recommends tonics, quinine and iron, diuretics,
and iodide of potassium, as advocated by Dr. Hitch, of Gloucesta-.
In mania the two heroic remedies, he remarks, are tartrate of anti-
mony and coca, each appHcable to one of the two principal forms of
the disorder. In those of good constitution, with signs of deter-
mination to the head, redness of the face and reaction, he gives
tartar emetic as an emetic and alterative. When he desires to
subdue great excitement he mixes the tartar emetic, in quarter grain
doses, with twelve grains of ipecacuanha, and gives two such doses
for two days, then slightly augments the proportion and administers
three doses for three days, until, in some cases, the quantity given
amounts to 30 grains of ipecacuanha and two grains of antimony per
day. At other times he produces nausea by adding very small doses
to all the drink taken by the patient. Li all those cases where
Engelken employs opium the author gives coca, with the same
indications in view as in dementia. But he would use neither coca
nor opium to induce sleep until all other means to reduce cerebral
congestion had failed.

As mania may be a phase of all other forms of mental disorder,
its treatment requires to be varied according to circumstances. In
epileptic mania he advises atropine and coca ; in erotic mania, cam-

£inor and bromide of potassium. In the treatment of hallucination
e has not met with any encouragement to use coca, but what he
finds most beneficial is strong coffee.

1867.] of P^chologieal Medicine. %&h

In melancholia warm baths^ particularly if prolonged^ and active
friction of the skin, exercise a salutary effect; but if these fail, the
writer gives an infusion of coca at bedtime, and repeats it the follow-
ing moming, and ofttimes its administration is followed by refreshing
deep. If these measures fail, he gives pills of camphor, henbane
and nitrate of potash, as sedative, and sometimes repeats them in the
course of the day.

Of the original memoirs noted among the contents of the volume
rf the ' Archives ' for 1865, there remain but two unnoticed in this
abstract: viz., a medico-1^1 report on a man accused of incendiarism
(found insane), and Girolami's critical annotations on the proposi-
tions of Castiglioni for amending the Italian lunacy laws, ^ese
two communications, the Umits allowed to this extract, we regret,
most stand over for future notice.

II. — German Psychological Literature,

% JoHH SiBBALD, M.D., Ediu., Medical Superintendent of the

District Asylum for Argyleshire.

Allgemeine Zeitschrift fur Psychiatrie,No\, xxiii, 1866. ''On
])elusions of the Senses^' ; Dr. Kahlbaum. ** Mania Acutissima oc-
cnrrinff during a paroxysm of Intermittent Fever '^; Professor
Ilrhardt. " iSe dinerential Diagnosis between Dementia Paralytica
and other cerebral diseases which produce Insanity and Paralysis '';
Dr. V. Krafit-Ebing. " Besearches concerning Hereditary Influence
in Derangement of the Mind.'' " Mental Freedom, a principle in
Forensic Psychology'' ; Dr.Wiebecke. " Adhesion of the Pia Mater
to the Cortical Substance of the Brain" ; Dr. L. Besser. " Pneumonia
and Insanity " ; Dr. Wille. History and Literature of Dementia
Paralytica" ; Dr. V. Kraffi-Ebing.

On Delusions of the Senses. — In this paper Dr. Kahlbaum pre-
sents a very interesting discussion on the nature of hallucinations
and illusions, of which the following is a resumS.

Among the symptoms of mental derangement, a peculiarly im-
portant place is occupied by delusions of the senses, which are de-
i^ngements in the special process of mental perception through the
^nses^ and are dependent on processes within the central organ.
These delusions exist as symptoms of insanity distinct from delusions
%A the judgment or intellect, while both combined comprehend those
derangements in the ideas and thoughts which concern the subject-
matter of intellectual action j and as such, both groups are opposed
to derangements in the form of thinking. There occur along with

236 Report on the Progress [July,

these delasions of the senses, regarded as derangements of the
central action of perception, derangements in the peripheral action
of the senses. These occur not only among the insane but also
among persons of sound mind, and they are usually associated in
one group with delusions of the senses, tnough they are essentially
distinct from them owing to the peripheral, extra-cerebral seat of
the exciting lesion. They bear the same relation to the essential
symptoms of insanity as other concomitant somatic lesions, such as
hypersBsthesia. Their particular significance in insanity consists
only in serving as a foundation for delusions of the judgment, just
as hypersesthesia or other somatic conditions may act.

The distinction drawn by Esquirol between hallucinations and
illusions may be to a certain extent admitted, in so far as, under the
term illusion, is understood delusions of the judgment concerning
sensible objects, and, under hallucination, delusions of the senses.
But illusions relate not only to sensible things and ideas obtained
through the senses, but also to non-sensible, moral, intellectual, and
especially abstract conditions ; and these non-sensible illusions are
frequent manifestations and essential symptoms in the insane, and
are only a peculiar kind of delusion of the judgment. The delusions
of the senses, hallucinations, or perhaps they might be better named
false perceptions, are not in all cases similar or completely analogous
phenomena, but exhibit a variety of outward manifestations, which
are connected with a corresponding manifold constitution of the
portion of the brain which is the organ of perception ; and this
constitution corresponds in its essential constituents with the results
of other observations and investigations. Besides the so-called
organs of the senses and nerves of sense, the external extremities,
and peripheral organs of the complicated system of apparatus, there
are especially two important central parts to be distinguished in each
sensory sphere. These are connected, one with the central root of
the nerve of sense, the other with the most central part of ther psy-
chical individuality, with the organ or principal seat of conscious-
ness; and both are connected with one another by conducting
apparatus. The first, and to a certain extent the more peripherd
organ has only to perform the function of simply receiving the sensory,
impression into the psychical interior ; it, so to speak, transform!^ the
objective influence which depends on physical action into psychical,
or bestows on it a psychical quality. This may be called the organ
of perception or of psychical metamorphosis. The other, which in
the route of perception is the more central organ, receives the sen-
sory stimulus which has passed through the organ of perception, and
renders it a permanent possession of the psychical interior. * After
the cessation of the objective stimulus, these permanent secondary
stimuli sink rapidly down to a very low degree of intensity, and are
only raised to greater intensity by certain impulses coming eithef .

1867.] of Psychological Medicine, 2:37

from within or from without. This organ again may be called the
o^an of apperception, and of memory. In addition to the con-
nection between perception and apperception, there are also con-
nections between the organs of perception and apperception, belong-
ing to the different sensory spheres, upon whose action depends the
concert of the different sensory impressions.

The organs of perception are certain grey structures situated at
the base of the brain, in the trunk of the brain, and in the medulla,
composed chiefly of ganglionic substance, and which are met with
in development as primary organs, and exist in analogous forms in
all the vertebrates. The organs of apperception, are certain portions
of the cortex of the cerebrum in the neighbourhood of the longitudi-
nal fissure, which appear in development as secondary forma-
tions, and are found among vertebrates more largely and deUcately
developed, according as the animals are higher in the scale of
classification.

While in the ordinary action of perception the course of the pro-
cess takes a centripetal direction there is also an opposite direction
of functional significance, upon whose existence depends the power
of attention, and the faculty of rendering conscious the ideas of
objects.

The delusions of the senses, or the pathological action of the cen-
tral apparatus of the senses, may be divided phenomenologically into
two groups : the' direct, immediate, or definite, and the indirect,
mediate, or indefinite. The immediate, direct hallucinations may be
observed at the moment of their occurrence, and, for their production,
subjective stimuli in the course of one of the sensory routes are sufii-
cient. This form of hallucination may have, in the first place, a
very subjective character, in which case its elements are very change-
able. Tliere are to be observed at the same moment examples of
fantastic false perceptions in several of the senses. Their excitation
appears to proceed from the inmost process of subjective conscious-
iiess and of the productive fancy (phantasmia) . Their origin is
perhaps to be explained as a superexcitability of the reproductive,
centrifugal sensory action, the reperception or centrifugal excitement
of reperception through consciousness. This may be called centri-
fi^al hallucination. In this case the hallucination appears either
^thout any external stimulus, or it is produced by an object of
^milar character to itself. In the second place, direct hallucinations
^y have a more objective character. Their nature may be more
'lidform, more permanent, and simpler. The seat of the false per-
^tion may be confined to a single sensory province. Its pro-
^tiction appears to be connected with a definite locality exterior to
^he domain of pure consciousness, and affects the consciousness with
^ force equal to that of an actual object (phantomia). Its origin is
to be explained as a process carried on nearer the centre, than the
VOL. xnr. IT

2^S Report an the Progras [July,

proper roots of the nerves of sense^ but probably in the neighbour-
hood of these roots^ that is, as a spontaneous excitement in the
organ of perception. This form may be named centripetal hallw
cination. In this case, the hallucination is either permanent or
nearly so, and may be csilei stable phantomia ; or it may occur only
at times of great emotional excitement, or of corporeal agitation, —
erethish phantomia ; or it may appear during tranquil contemplation,
but when the attention is powerfully exerted in a particular
direction.

The mediate, indirect Aallucinations, depend on a previous excite-
ment in another sensory province (reflex hallucination) ; or a sensor;
false reminiscence occurs spontaneously, either with or witho«
definite character (concrete and abstract phantorhemia) ; or there 3
necessary an external and individual object very nearly correspond
ing in character to the false perception, whose objective stimulci
blends with the deficient subjective stimulus, and forms a sing^7<
complete impression. This last is called by Dr. Kahlbaum, chang-
ing hallucination, partial hallucination, perception of secondary images,
or pareidolia.

Those manifestations which have been hitherto termed illusions,
are only in very small proportion actual delusions of the senses
(partial hallucinations) . For the most part they are pure delusions
of the judgment, while a few are false judgments, founded on im-
perfect perception, or deceptions produced in the peripheral organs
of sense and in external conditions. The nature of illusions consists
of a falsification of the judgment, by the influence of passion, or the
subjective tendency of the action of the intelligence.

The subject is discussed by Dr. Kahlbaum in a very full and in-
teresting manner, and illustrated with well-chosen cases ; and
whether his views be accepted entirely or not, we must regard
them as calculated to throw new light upon many of the charac-
teristic phenomena of insanity.

Mania ocutisdma occurring during a paroxysm of Intermittent
JR?t?er.-— Professor Erhardt, of Kiew, gives the details of a case pre-
senting this complication which became the subject of medico-legal
investigation. The patient, Nasar Titon Glot, was a young man of
thirty years of age, who had served as a soldier since 1855, and had
always borne an exemplary character. He had suffered in 1863
from an attack of intermittent fever of ten days^ duration. On the
1st of April, 1864 he was again attacked with ague, but did not
make use of any remedy. On the 6th of the same month he
walked to the bathing-room of a neighbouring village, about five
miles distant from where he lived. He had felt a. paroxysm coming
on before he left home, but fell quite well during, his walk. The
first rigor occurred on his arrival at the bath-house, but after he had

1867.] of P»i/chological Medicine. 239

remained some time in the vapour-bath and had also taken a hot
water bath it passed off. He remained an hour and a half in the
bath and then returned home. While dressing after the bath» the
cold sensation came on^ but when he had gone two miles towards his
liome the hot stage began^ and became so severe^ that he was scarcely
able to reach his dwelling. There he was met by Lucie K — , who,
with her mother lived in his house. The latter was completely
paralysed and lay on a low plank-bed. Glot immediately on entering
threw himself on a bench, and, according to his own account, fell into
unconsciousness, and in his opinion remained in that condition for
about an hour. As he came to his senses he felt himself better,
his head was freer, but he was conscious of pain in the genitals, and
he also perceived that the room was in disorder. The window and
the cooking utensils were broken, and the old woman lay no longer
on the bed, but beside him on the floor, and her neck was covered
with blood.

According to the account given by Lucie K — ^ Glot's expression
after his return from the bath was remarkably altered, and the per-
spiration was pouring from his forehead. On entering, he remained
os-j standing in the front room, and then turning round as if intending
to go into the other room, saying to the old woman, Marie K — ,
" Go, shut the front door and I will go into the next room.'' He
did not go, however, but tried to get upon the stove, and got down
again directly, then taking a new idea into his head he called to
Marie to give him a fur. When Marie had given him hers he put
it on, and threw himself upon his knees before the " holy picture,''
and remained there. He again prostrated himself before it, and»
taking the cross which he wore from his neck, called out, '^ Merciful
God ! I would kiss Thee were I not unworthy." Thereupon he
threw himself upon the floor and struck it with both head and hands.
He then took the cloak which he wore and tore it, his coat and his
shirt, and began to call out '^ Give me a knife and I will kill you
alL'^ Lucie K — being alarmed, ran out to call for assistance, and
took the knife and axe with her, but unfortunately forgot a shoe-
maker's knife which was on the bench. After her departure, Glot
first smashed the window-panes and the crockery, and then seized old
Marie £ — , dragged her from the bed and set himself to kill her.
When she begged him to spare her life, he replied, ^' Do not scream,
I will not kill you; that would be a sin ; but I will kill myself."
He then sat down on the ground, cut off his scrotum, and covering
himself with his doak, lav down. After an absence of half an hour
Lucie K — returned and found him in that position, l^e scrotum
and Glot's knife lay on the ground under the bench.

The surgeon who was sent for stopped the bleeding in the wound,
and Glot was taken to the hospital, where he had another paroxysm
of tlio intermittent. He never exhibited any further symptoins of

240 Rqmt on the. Progress [J^ly> «^

insanity ; and after a careful investi^tion he was set at liberty^ ai
having been labouring under transitory mania at the time of th
deed. Professor Erhardt discusses the medico-legal points fully ancS
especially controverts Gaspers rejection of mania transitoria as
valid condition of irresponsibiUty.

The clinical differential diagnosis between Dementia paralytica avtd
other cerehral diseases which produce Insanity and Paralysis. — Dr. 7.
Kraflft-Ebing believes that dementia paralytica, or as it is usually
called in this country, general paralysis of the insane, has been the
subject of two errors which have acted in opposite directions ; having
been by one set of authors undistinguished from several quite
different diseases, and having been regarded by others as confined
merely to one of its own varieties — ^that which is distinguished by
maniacal excitement and grand delusions. The principal diseases
with which according to him it has been confounded are given in
the following list.

I. Senile dementia with paralysis.
£. Dementia with paralysis originating in —

a. A^poplexia cerebri sanguinea.

b. Tumor cerebri.

c. Encephalitis chronica.

d. Partial sclerosis of the brain.

3. Dementia with paralysis following a primary psychosis and
produced by an extension to motor structures of the cerebral lesion
wliich caused the psychosis, or by complication with disease in other
parts of the brain.

4. Ataxic locomotrice, occurring in the course of a derangement
of the mental functions.

5. Dementia with paralysis resulting from epilepsy.

6. Alkoholismus chronicus.

7. Hysterical insanity with paralysis.

8. Saturnine paralysis with mental derangement.

9. Insanity complicated with

a. Progressive muscular atrophy.

b. Meningitis spinalis.

c. Degeneration of the medulla spinalis.

10. Paralysie pellagreuse.

II. Phosphoric and arsenical paralysis with mental derangement.
The author confines himself to the examination of the differences

between dementia paralytica and the first three in the list, and defers
the consideration of the others until sufficient material has been
collected to enable us to do so satisfactorily. He defines dementia
paralytica as a chronic, if not also non-febrile, disease presenting two
principal groups of symptoms, motor and psychical, which generally
make their appearance together and advance with a great variety of

1867.] of Psychological Medicine, 241

symptoms — in the motor group from simple but general disturbance
of co-ordination to pronounced general paresis, in the psychical
group through stages of melancholia, mania, and grand delusions,
or from an initiatory condition of simple weakness of mind to con-
tinually increasing and complete dementia. The disease runs a course
on the average of from two to three years, always ends fatally, and
on post-mortem examination presents, almost without exception, the
condition of periencephalo-meningitis diffusa chronica.

1. The following are noted by the author as marks of difference
between dementia paralytica and senile dementia with paralysis.

The age of the patients. According to Calmeil, Hoffmann, Stolz,
and KraiBft-Ebing himself, dementia paralytica occurs most frequently
from the 30th to the 45th year of age, while senile dementia seldom
occurs before the 60th year.

The sex. Dementia paralytica is infrequent among females while
no special immunity exists in either sex as regards senile dementia.

The exciting causes are not without a certain importance in their
bearing on the diagnosis, excesses in drinking and venery being
frequently causes of dementia paralytica, but not of senile dementia.

The duration of the disease is shorter in dementia paralytica than
in senile dementia.

Derangements of the functions of the higher organs of sense are
seldom complications of dementia paralytica, but frequently of de-
mentia senilis.

Inequality of the pupils is frequent in dementia paralytica, but
rare in dementia senilis : and when it does occur, being the result of
severe disease of the eyeball or brain, it is permanent, while in de-
mentia paralytica it is variable.

If dementia senilis commences with a maniacal stage the manifes-
tations are essentially different from those observed in dementia
paralytica. There are wanting the excessive impulse to movement,
the great disturbance of consciousness and confusion, and the tumul-
tuous grand delusions which characterise the latter. A childish
"Weakness soon supervenes, and the tendency to movement especially
is reduced to a childish activity, babbling, and restlessness.

Maniacal paroxysms occur frequently even in the advanced stages
of dementia paralytica, but they seldom recur in the senile disease.

Observations are wanting regarding the temperature, in order to
determine whether the maniacal condition with which dementia
senilis sometimes commences is accompanied with fever ; though it
appears improbable, h priori, that it should be accompanied w^ith ia-
flanunatory action. According to Meyer, the maniacal paroxysms in
general paralysis are always accompanied with fever ; and this state-
ment is corroborated by numerous observations of Dr. Krafft-Ebing.

In those cases m which both diseases commence with symptoms
of progressive weakening of the intelligence the derangements are

2 i'Z Report on the ProgreM P^lj^

dissimilar. In general paralysis there is greater disturbance of the
consciousness; the patient mistakes persons and localities^ or is
unscouscious of conditions of time and place. Failure of memory
is observed at a later stage than in senile dementia^ and refers at first
to the occurrences of youth. The mental disturbance in dementia
senilis frequently begins with great apathy, sleepiness, emotional
torpidity, and childish, complaining, irritable and intractable temper.

There is greater variety m the course of the mental disorder in
general paralysis — ^the appearance of grand delusions indicate that
disease.

The most important distinctive marks are furnished in the obser-
vation of the motor lesions. As regards the period of their appear-
ance, these lesions commence in general paralysis usually at the same
time as the mental, rarely a short time subsequent to them, and stiU
more rarely previous to them; in Dementia senilis the motor dis-
turbances follow the mental, and appear much later than in the
former affection. As regards the character of the lesion, in Dementia
paralytica it is general, but in D. senilis it is generally local and for
the most part unilateral; it is very rarely general. In D. paralytica
it exists originally as a lesion of the power of co-ordination, with
retention of muscular power, or if, on account of transitory oedema of
the brain as a sequel of neuro-paralytic hypersemia, or on account of
hsematoma of the dura mater, actual palsy should appear, it is only
transitory, incomplete, and rarely or only transitonly followed by
symptoms of irritation (contractions). In D. senilis, on the other
hand, there is true paralysis ; there is from the beginning a loss of
muscular power, from slight feebleness up to complete paralysis ;
and it is frequently unilateral, dependent on apoplexy, local softenings
in the brain, or unilateral atrophy. The course followed by the
motor symptoms in D. paralytica is very changeable, oscillating
between sudden palsy or ataxic and complete freedom from motor
lesion ; in D. senilis the paralysis is simply progressive or stationary,
and presents no intermissions.

Lesions of speech occur in both conditions, but manifested very
dissimilarly. In D. paralytica the speech is halting, trembling, and
hesitating, and is also very frequently changeable in its intensity.
Certain letters (s. v.f.) are difficult to pronounce ; the speech is hurried,
trembling, and the individual syllables smother one another; and
the lesion occurs early and constitutes a cardinal symptom. In D.
senilis the speech is more imperfect, as if a foreign body were in the
mouth, and the lesion is more a paralysis of the tongue, later in its
appearance, and only a secondary symptom. The use of false and
newly-invented words for the designation of objects is a not un&e-
quent symptom in D. senilis.

The tongue in those suffering from general paralysis is tremulous,
cecillating, unsteady, and tripping, owing to the disturbance of

1867.] <f Piychological Medicine, 243

co-ordination^ but these symptoms are absent in D. senilis ; there
the tongae frequently lies obliquely and cannot be properly protruded.
The muscular action of the lips is frequently convulsive and vibra-
ting in general paralytics ; in D. senilis there is often facial paralysis^
wiyness of the angles of the mouth, and unequal innervation of the
sides of the face — conditions which sometimes occur in D. paralytica
also, but, like palsies in general, only temporarily.

Paralysis of the sphincter occurs only towards the end of general
paralysis or in early stages is only transitory ; in senile dementia it
occurs early.

Neuro-paralytic hyperemia is frequent in D. paralytica and passes
quickly off. It has not been observed hitherto m D. senilis.

£pileptic and apoplectiform attacks are frequent in D. paralytica,
but always transitory and leaving very httle subsequent trace.
Epileptic seizures have not, to Dr. Kraft-Ebing's knowledge, been as
yet observed in D. senilis, and when apoplectic attacks do occur
they are connected with grave cerebral symptoms, and leave decided
results behind.

Grinding of the teeth, which is a frequent symptom in general
paralysis is not found in senile dementia. On the other hand, there
is often tremor in the latter disease amounting to paralysis agitans.

2. The author next takes up the differential diagnosis of D, para-
Ijftica and ordinary Dementia with paralym; taking first that form
which originates in sanguineous apoplexy.

This is also an affection which exhibits a course of associated
mental and motor lesions, especially when it affects the cortical sub-
stance of the cerebral hemispheres, and is followed by atrophy of the
structure. In this affection there are a progressive decay of intel-
lectual life and a progressive disturbance of movement. The extension
of apoplectic areas, the manner and rapidity of occurrence of the
consecutive alterations in their neighbourhood (atrophy, hydro-
cephalus), their locality, and the various kinds of apoplectic relapses,
give such individual characters to the course of the disease that it is
difficult to make out definite general features, and confusion with
the forms assumed by general paralysis is conceivable. At the same
time some marks may be selected by which to distinguish the one
from the other. The observation of the motor manifestations is ol
the greatest importance.

As regards the time at which these lesions appear ; they precede
the mental disorder by a considerable period. This distance betweeipi
the appearance of mental and motor disturbance is at least longer
than in the few cases of D. paralytica in which the motor disturbance
precedes the psychical.

The motor lesion is paralytic and not co-ordinate.
It is generally unilateral, not general, and either remains stationary
or retrogrades, but is never progressive. It always lasts longer (always

244 Report on the Progrtu [J^Jj,

some weeks) when it retrogrades than when there occars in the course
of D. paralitica a by no means rarely occurring transitory hemi-
plegia^ which passes off in a few days or even hours ; and those lesions
observed in the course of apoplexy never retrograde so completely.

Frequent concomitants in the paralysed members are contractions
and ex-centric pains, indicating inflammatory irritation in the neigh-
bourhood of the apoplexy ; symptoms which are absent in general
paralysis.

The disorders of sensibility, of the alimentary nerves, and of the
organs of the senses, furnish no decisive indications of the difference
between the two forms.

Apoplectic attacks occur both in the dementia with paralysis
resulting from A. sanguinea and in D. paralytica. In the former
only are they generally dependent on recent extravasation of blood.
The seizures exhibit great similarity in their symptoms, such as
sudden onset, more or less complete loss of consciousness and of
sensibility, relaxation of the muscles, loss of motility and of reflex
excitability, weak cardiac impulse, and thready pulse. There are,
however, besides the greater frequency of the apoplectic attacks in
D. paralytica, the rapidity with which the alarming symptoms pass
off in that disease, and their complete disappearance, which may be
voted as diagnostic signs. Within a few hours all have passed away
and the patient awakes in the same state as before, or merely with a
certain xiulness of sensibility and confusion ; and if paresis of the
muscles of the trunk and limbs still remains, it, as well as the lesion of
speech, disappears in a short time. In the other malady the paralysis
always takes the heniiplegic form, while in general paralytics both
sides of the body are affected.

The researches regarding the electro-muscular contractility and
sensibiUty are useless for the purposes of differential diagnosis. In
the examination of those sufferers from general paralysis. Dr. v.
Kraflt-Ebing found the existence in every case of electro-muscular
contractility and sensibiUty, as also in those suffering from cerebral
paralysis.

In the apopletic disease the speech is affected in a similar manner
as in dementia senilis, and may be useful in the diagnosis from P.
paralytica ; and in Uke manner there is frequently obliquity of the
tongue and uvula.

The comparison of the psychical manifestations also furnishes data
for distinguishing the two diseases. Besides their late appearance
in apoplexies, which are followed by cerebral atrophy, it is worthy ol
notice that the intellectual capacity gradually declines; there is a
primarily supervening dementia in opposition to what occurs in D.
paralytica, where this is for the most part secondary. The maniacal
attacks and grand delusions, which are so frequent in D. paralytica,
are not present here; and where they do appear the idea thai

1867.] oj Psychological Medic'me. 245

the insanity is the result of apoplexy is excluded. There can be
confusion between the two only in those rare cases in which
D. paralytica commences with a primarily supervening dementia.
But the dementia arising from atrophy of the brain after apoplexy
comes on some time after the motor symptoms; it then progresses
more rapidly than in general paralysis, and it wants the characteristic
variety of the symptoms. Apoplectic dementia might be graphically
described as a sudden fall from a height; while D. paralytica declines
in a gentle curve. It is also a peculiarity of apoplectic dementia
that the memory fails from the first, and frequently in a circumscribed
manner, the power of recalling the special names of places and persons
being lost. The disorder of consciousness is also not so marked as
in general paralysis.

The duration of the malady is, when not cut short by a fatal
apoplectic seizure, longer than the average duration of general
paralysis, generally lasting several years.

Tumours of the brain also give rise to a group of symptoms which
may be confounded with D. paralytica ; and in fact such mistakes
have been made. (Aub^nel and Sauze : Cancer du Cervelet, ayant
simule une paralysie generale, etc. Gaz, desHopitaiix, 1 85 7. No. 123.)

This difficulty is in general not to be apprehended, as we have
here to do more with a localised disease, with well-defined paralytic
symptoms, rarer affection of the speech than in general paralysis,
with dissimilar course, and differently implicating the psychical sphere.
Still there are many things common to the two diseases ; tumours of
the cerebrum, and particularly of the hemispheres, sometimes present
a resemblance to D. paralytica. We will here confine ourselves to
the consideration of certain symptoms which careful statistics (Fried-
reich, Lebert, Ladame, etc.) have established as characteristic of the
symptomatology of tumours of the brain.

The first symptoms are generally much more latent and indefinite

^ than in D. paralytica. The mental symptoms are almost without

exception absent, and M^e find those connected with sensibility most

Erominent. Headache, which is a rare and unimportant symptom in
). paralytica, appears here as a cardinal symptom. There is also
vertigo, frequently vomiting, and not rarely loss of sight. These
symptoms are developed successively, and increase with frequent
remissions in the course of mouths or even years.

The age of the patient is of no value in the diflFerential diagnosis
of these diseases.

The observation of disorders of the senses, especially with tumours
at the base of the brain, is of more value.

Amaurosis is frequently developed, and the ophthalmoscope reveals
a considerable excavation of the pupil with atrophy of the retina.
There is not uncommonly a progressive loss of hearing, and in some

246 Report on the Progress [July,

cases also of the sense of smell. These symptoms are absent in
D. paralytica, where the base is left intact, or they are only found as
complications depending on peripheral disease of the organs of sense*.
Double vision is not unfreqaently produced by tumours of the brain
through paralysis of the thirds fourth, and sixth pairs of nerves.

Disorders of sensibility are more frequent ana more pronouncecf
than in general paralysis. Headache often continues to a very dis-
tressing extent for long periods. Cutaneous anaesthesia is not un-
common ; and, what is peculiarly characteristic, it is unilateral, and
is generally accompanied by unilateral motor lesion (paralysis). It
also is of longer duration than the temporary ansesthesia which may
be observed in D. paralytica. Sometimes also anaesthesia dolorosa
has been observed.

The motor lesions are important in regard to their character,
extent^ the period of their appearance and course, and are often quite
distinctive for the purposes of diagnosis. They are especially not
ataxic, but paralytic ; though with tumours of the cerebellum there
is sometimes a disturbance of co-ordination in the muscles that pre-
serve the equipoise of the body, but never in those of the extremities.
They never commence in a general form, being always circumscribed
and exhibiting generally the hemiplegic and never the paraplegic
form. They are developed slowly but progress steadily and with
slight remission; there is generally very Uttle variation in their
course, and they only become general in the terminal period of the
disease. The gait of those suffering from cerebral tumour is there-
fore different from the paralytic ; the former merely trails the foot
behind, the latter walks unsteadily, carelessly, with wide steps, and
awkwardly.

The paralyses of the nerves arising at the base of the brain,
particularly the facial, oculomotorius, trochlearis, and abducens,
which accompany tumours at the base, are also important symptoms.
They exhibit the well-known paralysis in the muscular groups which
they supply, histrionic paralysis, ptosis, and squinting, with double
vision ; and they are further distinguished by their occurrence on the
opposite side of the body from the paralyses of the muscles of the
extremities ; and they also show their peripheral character by the
diminution of the electro-muscular contractility in the groups of
muscles, and can therefore have their cause only at the basis of the
skull. Tlie consecutive symptoms of the paralysis not unfrequently
correspond with the anatomical position of the nerves at the base,
as they become involved in the tumour during its extension.

Lesions of speech are certainly much rarer than in D. paralytica.
They do not appear at the commencement, are essentially paralyses,
and not lesions of co-ordination, and are not subject to the variations
in intensity, as in that disease.

It is more difficult to define the difference in the mental symptoms

1867.] of Psychological Medicine, 247

whicli are exhibited by the two maladies, particularly in those cases
of D. paralytica which are marked by a primary progressive de-
mentia. The psychical lesions, which almost without exception
follow the motol", are developed after months, and do not show such
close connection with the motor lesions as in general paralysis. The
affection of the mind begins, except in rare instances, with symptoms
of a slowly advancing decay of the intellectual capacity; and
Krafft-Ebing has only found one case, which is detailed by Lalle-
mand, in which grand delusions appeared. The occurrence of
this condition, as well as of well-defined fonns of acute mania, sug-
gests decidedly D. paralytica, and makes it in the highest degree
improbable that we have to do with a cerebral tumour. The course
of the mental lesion here is almost without exception one of pro-
gressive stupidity, advancing to complete dementia, with great inco-
herence, and tendency to somnolence ; the features present the ex-
pression of stupid astonishment, and the memory becomes extinct.
Intercurrent epileptic attacks, when they occur, exercise a greater
influence on the progress of the dementia than in D. paralytica ; but
they imperil the mental existence less ; indeed it sometimes returns
temporarily after such attacks to its former condition. The increasing
mental degradation is never interrupted, except temporarily, by me-
ningeal irritation, or disorders of the circulation excited by the
tumour giving rise to symptoms of irritation, excitement, restless-
ness, haUucinations, purposeless impulses, &c. ; and it never assumes
for any considerable period any of the well-defined forms of insanity.

Partial Sclerosis of the Brain, an affection which has only recently
I'eceived attention, presents sufficient resemblance to some forms
of general paralysis to deserve notice. Unfortunately, a sufficient
number of cases of this peculiar condition have not been reported to
enable us to determine its exact symptomatology, or to mate a defi-
nite comparison with D. paralytica; and it must suffice to direct
attention to the possibility of confounding the two diseases.

From the cases which have been published by Frerichs, Valentin,
Cruveilhier, Duplay,' Hirsch, and others, it appears to be chiefly
a disease of youth, of slow progress — lasting even ten years, and
latent in its origin. The motor symptoms appear early, beginning in
the lower extremities with incomplete paralysis, which progresses up-
wards, and only at a late period affects the muscles of speech ; these,
however, become afterwards completely paralysed. Convulsions are
rare, generally partial, occur chiefly at the commencement of the
disease, and frequently there is occasional noticeable tremor. Ex-
centric pains are not infrequent. Mental symptoms generally appear
late, and consist of increasing weakness of intellect, apathetic,
childish behaviour, and causeless variableness of temper. The dif-^
ferential diagnosis from D. paralytica is to be found in the slow

248 Rejjorf on the Progress [July,

progress, the youth of the patient, the want of lesions of co-ordina-
tion, the originally partial and only gradually extending paralysis,
the late implication of the muscles of speech, and the late appear-
ance of mental derangement.

Encephalitis chronica is the next affection iirhich has to be con-
sidered. An attempt to demonstrate the differences between the
local chronic softenings and inflammatory conditions of the brain,
and general paralysis, presents, in regard to many cases, almost insur-
mountable difiiculties. The form of the cerebral softening is infi-
nitely variable according to the seat and the kind of the local disease,
and the course of the malady in some cases presents great variation.
When the softening occurs idiopathically it is generally developed
in a previously diseased brain ; and, on the other hand, the motor
lesions, which else would facilitate the diagnosis, exhibit a varie-
gated mixture of symptoms of motor disorder with fluctuating
course, which is very similar to what is seen in D. paralytica. Ac-
accordingly the differential diagnosis which the author attempts
is expected to be received witli great reservation.

The motor lesions here also supply the most important points of
difference. They indicate as a rule local disease, and, though, in
comparison with tumours of the brain they are more extended, they
are never of general extent, and they are principally of a hemiplegic
character. Although they are frequently variable in their intensity,
and exhibit marked remissions, they are more consistent than in
D. paralytica. Lesions of co-ordination are rare and only temporary
symptoms ; and the motor affections are, as a rule, true paralyses.
The frequent occurrence of contraction in encephalitis chronica is
also of peculiar diagnostic importance. Lesions of speech usually
appear early, and advance more suddenly than in D. paralytica; and
they are chiefly due to paralysis of the muscles of speech, and not
to derangement of co-ordination.

The disorders of sensibility are also worthy of notice. Persistent
and intense headache is often present. Ansesthesise and hyperses-
thesise are not infrequent ; they are more lasting and frequent, and
more pronounced than in general paralysis. Excentric pains are
very significant, especially when, as is generally the case, they are
unilateral, and accompanied by contractions.

Amaurosis often supervenes; inequality of the pupils is only
observed temporarily after apopleptic attacks, and is never constant,
as in D. paralytica.

Mental disturbances, when they occur, consist of progressive decay
of the mental capacity, and never amount to grand delusions or
maniacal paroxysms ; though Durand-Fardel reports some cases in
which delusions of being persecuted, with intercurrent hallucinations,
appeared. As a rule there are increasing weakness of inemory,

1867.] of Psychological Medicine. 249

childish, fretful temper, forgetfulness of the names of objects and
persons ; in some cases quiet delirium, and involuntary repetitions of
meaningless sentences.

The course is more rapid than in D. paralytica, being on the
average a few months, and only more protracted in exceptional
cases. Among 105 cases of Andral's there were one of a year's and
two of three years' duration.

.The last pathological condition which is discussed by the author
is that form of dementia with paralysis following a primary psy-
chosis, and produced hy the extension of the cerebral affection^ which
was the basisT of the latter, or by an additional cerebral lesion.
Those cases may in the first place be comprehended under this head,
in which a local lesion is superadded as a terminal condition to all
previously existing and advanced psychoses (apoplexy, encephalitis
chronica, pachymeningitis interna, sclerosis, atrophy, &c.), and
exhibits symptoms of increasing mental and motor incapacity.
Such are the by no means rare cases in which mental derangements
in aged persons, instead of passing on to resolution, pass, by the
supervention of senile atrophy of the brain, with consecutive hydro-
cephalus e vacuo externus and internus, intermeningeal and cerebral
haemorrhages, into the condition of senile dementia with paralysis.
For inaccurate observation may easily make it appear that the psy-
chosis was the commencement of D. paralytica, and that the symptoms
of motor lesion had been previously latent, or had not existed ; or,
what is still more unlikely, that D. paralytica had supervened as an
independent psychosis complicating the course of the first; this
latter view would have at one time been supported by Esquirol,
Delaye, Calmeil, and Georget. We do not require to discuss
whether the occurrence of D. paralytica as a complication is possible,
but in the cases in which there has been an opportunity of exact
and trustworthy observation, it has appeared tha;t either the psy-
chical disorder was accompanied from the commencement by motor
symptoms which, from not being paid proper attention to, or on
account of their trivial character, had been overlooked ; or that there
had been a confusion of D. paralytica, with local apoplexies, cerebral
softening, tumor cerebri, &c., and their accompanying dementia and
paralysis.

The diagnostic marks for the distinguishing the motor lesions in
general paralysis from those produced by circumscribed pathological
changes have been already given. But it is more difficult, though
not unimportant in these cases of secondary dementia with paralysis,
to ascertain whether the preceding conditions of melanchoha, mania,
grand delusions, &c., are distinct, from those which occur in
D. paralytica. The solution of this question is so much the more
important, as the symptoms of ataxy, even trembling of the tongue

250 Report on the Progreu [July,

and slight disturbance of speech occur in anaemic^ exhausted^ men-
tally deranged patients^ particularly among females, who never
become general paralytics, and may therefore easily be the subjects
of false prognosis. Without undervaluing the motor symptoms in
commencing D. paralytica, it is well to be cautious in giving an
opinion in the cases of those patients suffering from anaemia, in
which that condition affects the nervous centres. It is therefore of
great value to be well acquainted with the psychical symptoms which
may distinguish general paralysis from an ordinary psychosis. We
here approach a subject which is still much debated ; and we are
by no means in a position to furnish positive pathognomonic signs,
which are exhibited only by D. paralytica. Here again we have to
r^st our diagnosis on the general features and course of the disorder.
Neither the melancholia described by Baillarger, nor the grand
delusions which were till recently considered characteristic of this
disease, are infallible proofs of its existence. Fortunately the
alienist is seldom obliged to make a diagnosis purely from the psy-
chical lesions, as the motor lesions, as a rule, soon manifest them-
selves ; and the disorders of the circulation, congestive symptoms,
especially of the neuro-paralytic form, unilateral or general hyperse-
mia, present themselves in most cases. The variations in tempera*
ture of those who are suspected of general paralysis also appear to
be worthy of attention. According to the admirable researches of
Ludwig Meyer this affection is by no means non-febrile, and its con-
ditions of maniacal excitement are generally associated with con-
siderable elevation of temperature, which he refers to exacerbations
of chronic meningitis. This pathological theory which Meyer ad-
vances is controverted by Krafffc-Ebing, who mentions a case in
which he observed these elevations of temperature, and in which
there was no trace of meningitis to be found on post-mortem exa-
mination. The ordinary maniacal paroxysms which occur in simple
periodic mania exhibit no such elevation, but rather a lowering of
the temperature. In delirium acutum, and also in the maniacal
stages 01 acute meningitis, and of zymotic diseases, there is an eleva-
tion.

The author gives the following as the chief diagnostic marks of
general paralysis, in which he agrees generally with those which
have been laid down by Talret. They are chiefly, the great varia-
tions in the symptoms, the frequent and apparently arbitrary trans-
formation of one form of mental affection into another, which gives
the disease a proteiform character; there are, besides, the frequent
and often unexpected remissions, and indeed even apparent inter-
missions in the course of the malady, the capricious occurrence
and frequent relapses of maniacal excitements, even when dementia
is far advanced, and the rapid terminations of the paroxysms. The
great derangement of consciousness is still more important. Time

1867.] of Psychological Medicine, 251

and place, past, present, and future, have no existence for such
patients ; they are the children of the moment, and the greatest
dreamers. There are further to be notieed the early occurrence and
impetuous course of mental debility. It shows itself in all depart-
ments of the mental life, deficient power of apperception, imperfectly
associated ideas, serious impairment of memory, slowness in, or
complete incapacity for, any kind of reasoning or abstract thought.
The manner in which the will is affected is also remarkable — ^the
patients are easily stimulated to apparently strong resolutions, from
which they are as easily diverted by the most deceptive and unte-
nable reasonings. No other patients are so easy to lead or to
deceive as the general paralytics.

Though grand delusions are found in patients not suffering from
general paralysis, still they are rightly considered as important
aids in our diagnosis ; and indeed there are peculiarities in such de-
lusions among general paralytics which are of great importance, and
vhich have been well described by Falret. In the magnificent de-
lusion of the general paralytic, there is a want of sense, or rational con-
nection of ideas ; it includes the most opposite, and logically incom-
patible ideas as facts. In those deranged in this manner, we look
in vain for the individuality ; the paralytic has no ego. Generally
there is no unity in consciousness, such as ordinary delusional in-
sanity (the Wahnsinn of Griesinger) presents ; there is no attempt
to reconcile the apparent facts of the present with those of the past,
as he does not feel their incompatibility. There is a failure of mental
as well as of motor co-ordination, a sign of the general mental weak-
ness, which gives a unity to the form of the malady. The delusions
are enormous and extravagant, and have no relation to the former
ego\ they are quite foreign in character, and changeable every
moment. The law of variableness of symptoms, shows itself here
also, as in everything connected with D. paralytica. The exalted
ideas give place suddenly to depressed ones ; those who have been
filled with the grandest and most extravagant delusions suddenly
believe themselves divested of everything and think themselves dying
in most abject misery. These changes in the moods, and the de-
lusions associated with theln, have a peculiarly desultory character,
which is never found in simple delusional insanity.

In these cases also where D. paralytica exhibits symptoms of de-
mentia from the commencement, there are distinguishing marks by
which they can be separated from ordinary dementia. Frequently
they manifest slight grandiose, though faint and fragmentary de-
lusions ; and the self-consciousness is almost always lively and gaily
coloured, and not impassive or even depressed as in ordinary
dementia. These are almost always hallucinations^ and ideas of time
and place are more disturbed than in other similar conditions; mani-
acal exacerbations occur, which are generaUy accompanied by elevation

252 Report on the Progress [July,

of temperature and recede rapidly. In these cases also there is not
that peculiar forgetfulness of certain words, which is so remarkable
after apoplexy ; and the memory of early occurrences is the first to
be affected, that of recent events remainmg comparatively long
intact.

Further researches concerning Hereditary Influence in Insanity, —
In this paper Dr. Jung reproduces the details of the article which
appeared in the April number of this Journal for 1866, by Dr.
Grainger Stewart, and he shows how strongly the conclusions of the
British physicians corroborate those arrived at in Dr. Jung's pre-
vious paper, which was noticed in our last quarterly report. He
also discusses at some length the important bearing which hereditary
influence exerts, both in the character and curability of the derange-
ment.

Mental Freedom : a principle in forensic Psychology, — Dr.
Wiebecke, the medical superintendent of the asylum at Kaiserswerth,
discusses the views which have been maintained respecting human
responsibility. He reviews at some length, the views of the philoso-
phers Jacobi, Spinoza, Kant, and Schopenhauer, and arrives at the
conclusion, that the assertion of the transcendental freedom of the
will is theoretically false, and is quite insuflBcient as a foundation
for responsibility. He agrees rather with the views of the material-
ist Schopenhauer ; though he maintains that this belief does not
interfere with our ideas either of religion or morality.

Adhesion of the Pia Mater to the cortical substance of the Brain. —
Dr. L. Besser, of Siegburg, attributes this condition to four causes.
1. Dryness of the tissue, which may sometimes result from post-
mortem changes. 2. From loss of blood after exudative processes.
3. From softness or looseness of the cortical substance itself, or, as
Guislain said, " a want of cohesion.^' 4. From proliferation of the
neuroglia and of such part of the adventitious coat of the vessels as has
its matrix in the neuroglia. This last cause is what the author
dwells most upon, and has illustrated by microscopical investigation
and demonstration.

Pneumonia and Mental Derangement, — Dr. Wille reports seven
cases of associated pneumonia and insanity, all of which he has met
with during two years and a half. In four of the cases the mental
derangement appeared with the development of the pneumonia ; in
two cases it appeared during its resolution, and in one during re-
convalescence. In four cases there was hereditary or family ten-
dency, and one was a drunkard. Four of the seven died when the
puhnonary disease was at its height; in two, complete recovery took

1867^] of Psychological Medicine, 26S

place, as regards the mental condition ; while recovery from both
physical and mental lesions occurred orJy in one. In the four fatal
cases, cerebral hjpersemia was found in two, ansemia with signs of
previously existing hypereemia in one, and periencephalitis acuta in
the fourth. In one of the other cases there was cardiac disease
with disturbance of the cerebral circulation ; in another there was
probably anaemia, and in the last, the condition was probably
hypersemia. The form of the mental disorder exhibited, did not
appear to possess any peculiarity. In three of the cases in which
the mental and physical symptoms arose together, the disorder took
the form of acute mania; in the other case there was melancholia
with great excitement ; in the three cases in which the derangement
occurred during convalescence, the form of the insanity was melan-
cholia in two cases, and delirium of a maniacal character in the
other. In the two melancholic cases there was probably anaemia of
the brain. The author believes that there is no special character to
he discovered in the mental symptoms of these cases, so that the re-
sults of the inquiry is only negative. As an aid to diagnosis and
treatment, he recommends observation where practicable, by means
of a thermometer, as pecuUarly useful in asylum practice.

The History and Literature of Dementia paralytica, — ^This is a

supplement to the paper by v. Kraft-Ebing, of which we have

^ady given a pretty complete account. It is unnecessary here to

^^fer particularly to this article, as it consists merely of a short

fiterary history of the disease, it is followed by a list of 190 books,

Pamphlets, and periodicals, in which contributions have been made

^o our knowledge of the disease, the first which is quoted being

^ Willis de animfi, brutorum,'' Amstelodami, 1672.

We have thus completed in these two Beports (April and July) an

^ipalysis of the contents of the chief German publication on Mental

^^Jisease, the Zeitachrift fUr Psychiatric for 1865 and '66. Our

^^eaders will observe the varied research and ability displayed in many

K)f these papers. We much regret that our limited space compels us

^n the present occasion to deier a critical notice of the other two

<5erman journals on this subject, the Correspondenz Blatt dei*

deutschen Gesellschaft fur Psychiatric with the ArchivfUr Psychia^

trie and the Irren Freund, We shall hope on a future occasion to

remedy this omission.

VOL. xoi. 18

254 [July^

PART IV.-NOTES AND NEWS.

Presentation of l}r, Conollifs Bust to the Rojfal College of

Physicians.

At the April meeting of the Royal College of Physicians, Dr. Tuke
attended, witn Baron Mundy, M.D., and Dr. Maudsley, to formally present
the bust of the late Dr. Conolly to the College in the name of the Medico-
Psychological Association.

Mr. President and Fellows, said Dr. Tuke, it is my privilege with your
kind permission to appear before you to-day, with Baron Mundy and Dr.
Maudsley, as representatives of the Medico-Psychological Association, a
society well-known to you, as including many Fellows and Members of your
learned body, and which is especially proud of bearing on its list of honorary
members, the beloved and respected name of Sir Thomas Watson.

At the last Meeting of our Association held in Edinburgh, the Bust of
the late Dr. Conolly, of whom I will only say that he was while living the most
esteemed of our members, was presented to us by our friend and asso-
ciate. Baron Mundy. It was at this meeting proposed by me and seconded
by Dr. Maudsley, who is, like myself, a son-in-law of Dr. Conolly, that this
bust now, sir, at your right hand, should be offered for the acceptance
of the President and Fellows of this College. This resolution was unani-
mously adopted, and I attend here in the unavoidable absence of our Presi-
dent, Mr. Commissioner Browne, whose official duties detain him in Scotland,
to submit this resolution to the Comitia, and especially to introduce to you,
sir, and to the Fellows present, the distinguished foreign physician, to wnose
great liberality and appreciation of the talent and philanthropy of Dr.
Conolly we are indebted for this memorial of him, which we hope the
President and Fellows of the College will honour the Medico-Psyohological
Association by accepting.

I may add, sir, that Baron Mundy is a talented physician, well known in
his own country and in France, for his philanthropy and for the earnestness
of his attempts to ameliorate the condition of the insane. During the last
war, he gave his services to his country as a volunteer, and attained the rank
which he now holds, of Staff- Surgeon Major in the Austrian Army.
Baron Mundy then said : —

Sir Thomas Watson and Gentlemen, — I was highly gratified at the accep-
tance of my humble present by my fellow associates, and likewise proud of
the place proposed by the Medico-Psychological Association for it, subject
to your kind assent. I feel myself greatly honoured in standing to-day be-
fore you as one of the delegates entrusted with the offer of this token. It
is certainly neither here in this place, nor now, that I am permitted to
eulogise a man who will live in the recollection of posterity. But allow me,
before I retire, to allude on this occasion to a passage in your oration of last
year, in which you, after the eloquent tribute paid to our lamented friend,
censure, so justly and energetically, the system of torture practised before
the time of Conolly even in your own country. You have been enjoying
for almost a quarter of a century the work of the great man who is no more;
and still your neighbours, close to your own shores, have yet, at the moment

1867.] Notes and News. 255

1 address you, two thousand unfortunate beings tied in strait-jackets ; and

the total number of insane on the continent confined in cells, fastened in

beds, and strapped up in strait-jacitets, amounts in 1867 to fiitj thousand.

It is for me, as a foreigner, a humiliation, and perhaps at the same time a

proof of mj professional courage, that I denounce these facts before so high

an authority as yourself, and on so solemn an occasion as this of to-day.

Sut my aim is only to impress on you the importance of your continuing to

censure this barbarous practice ; the more so, as your countrymen, induced

l)y the man whose bust now stands before you, have proved that lunatics can

l>e successfully treated otherwise ; and thus you have conferred the greatest

benefit on the unhappiest part of our fellow-creatures. ''The monument

which, afler my death, I wish to be erected for me on the continent is the

practice of non-restraint; and may this soon be a reality !'* These words I

frequently heard from the lips of a man to whom you so often listened with

delight in this same room, and whose marble effigy we have now to beg you

to accept and place here in perpetual remembrance of him.

Sir Thomas Watson, in reply, pronounced a touching and graceful eulogium
upon the late Dr. Conolly in the following words : —

Baron Mundy and Dr. Tuke. — The Fellows of the College of Physicians,
here in full Comitia assembled, authorise me, their President, to express to
you, in their name and my own, our gratification and gratitude for the
privilege which we owe to your concurrent liberality of possessing and of
placing permanently within our walls the marble bust of one of our body,
whose death we, like you, have but recently been deploring, and whose
memory we, like you, desire to cherish and perpetuate — the late Dr. John
Conolly. To you, Baron Mundy, we offer the tribute of our respect and
admiration for your munificence in procuring so costly and graceful a me-
morial of your and our departed friend. And to you. Dr. Tuke, and to the
Society represented by you — the Medico-Psychological Association, to whom
the bust was in the first instance presented by Baron Mundy, — we have to
tender our grateful acknowledgment for the honour you have done this
College by resigning it into our Keeping. And again, thanks are due from
Qs to the Baron for his gracious and ready consent to that transference.
Our sculptured treasures, gentlemen, are not numerous, but they are toler-
ably select. I do not scruple to say that the bust of Conolly is not un-
worthy of being associated here with those of Sydenham, of Mead, of
Harvey, and, coming to*nien of his own time, of Matthew Baillie, of Halford,
of William Babington. Like theirs, or some of theirs, his name will go down
to a remote posterity, and be reckoned among those of the greatest and most
noble benefactors to a very suffering portion of the human race that our pro-
fession and our country have ever produced.

Br, MavdsUy on the Phy Biology and Pathology of the Mind,^

Ds. Maudslbt has had the courage to undertake, and the skill to execute,
what is, at least in English, an original enterprise. His book is a manual of
mental science in all its parts, embracing all that is known in the existing
state of physiology. There have indeed been more than one attempt to include
something of physiological observation in the investigation of mental phe-
nomena. Dr. Abercrombie, Professor Bain, and Mr. Herbert Spencer must
have the credit which is due to those who have led the way in giving this

* * The Physiology and Pathology of the Mind.* By Henry Maudsley, M.D.
London : Macmillan and Co., 1867.

256 Notes and News, [July,

direction to mental science. The revolution, for it is nothing less, which has
taken place in this branch of knowledge was begun by the psychologists
themselves. But it required a professional physiologist to grasp all the
phenomena of the nervous system, its normal and abnormal conditions, in
one view, and to treat them exclusively on the basis of observed facts. Many
and valuable books have been written by English physicians on insanity,
idiocy, and all the forms of mental aberration. But derangement had always
been treated as a distinct subject, and therefore empirically. That the
phenomena of sound and of unsound mind are not matters of distinct inves-
tigation, but inseparable parts of one and the same inquiry, seems a truism
as soon as stated. But, strange to say, they had always been pursued
separately, and been in the hands of two distinct classes of investigators.
The logicians and metaphysicians occasionally borrowed a stray fact from
the abundant cases compiled by the medical authorities ; but the physician,
on the other hand, had no theoretical clue to his observations beyond a
smattering of dogmatic psychology learnt at college. To effect a recon-
ciliation between the physiology and the pathology of mind, or rather to
construct a basis for both in a common science, is the aim of Dr. Maudsley^s
book.

Such a book cannot, however, offer itself as complete or final. In the
present state of nervous physiology, though enough has been ascertained to
enable the main lines of mental science to be laid down, there is still much
that is obscure and uncertain. We have not as yet any satisfactory know-
ledge of the functions of the different parts of the cerebral convolutions.
The anatomists cannot even agree on any convolution as peculiar to man ;
all that they can surely say is, that his convolutions are more complex and
less symmetrical than those of the monkey. Dr. Maudsley's caution is not
the least of his merits ; he will not advance beyond ascertained facts, how-
ever tempting the theory may seem. The attempts to assign language to the
third frontal convolution of the left hemisphere of the brain he will not adopt,
because the observations reported are unsatisfactory, and directly contradic-
tory observations are overlooked.

For the old method of psychology, by the interrogation of consciousness,
Dr. Maudsley entertains the same feeling as Bacon did for the physics of the
Aristotelian schools. Metaphysics have indeed been long sinking into
merited contempt. They are cultivated only by those who are engaged, not
in action, wherein the true balance of life is maintained, but in dreaming in
professorial chairs. An ambitious youth here and there goes through an
attack of metaphysics, as a child goes through an attack of measles, and pro-
cures thereby an immunity from a similar disease for the rest of his life.
And there are dabblers in metaphysics who remain youths for life. By the
rest of mankind, whether men of the world or men of science, metaphysics
are as little regarded as scholastic theology. Dr. Maudsley not only con-
demns metaphysics, but renounces that empirical psychology which attained
so much renown in the last century, and was the foundation of so many
reputations from Descartes to Sir William Hamilton. He regrets that Mr.
J. S. Mill should have committed himself to the psychological method, and
exhibited so much zeal on so desperately forlorn a hope. He wonders that one
who has done so much to expound the system of Comte should on this one
question take leave of it entirely, and follow and laud a method of research
which is directly opposed to the method of positive science. Self conscious-
ness Dr. Maudsley sets aside as incompetent to supply the facts for building
up a truly inductive psychology. Consciousness is not reliable even in that
of which it does give information. Descartes laid it down as the fundamental
proposition of philosophy, that whatever the mind could clearly and distinctly
conceive was true. 1 et, if there is one thing more clearly and distinctly

1867.] Notes and News. 257

conceived than another, it is the madman*s delusion. Further, the revela-
tions of consciousness reach only to conscious states. But mind and con-
sciousness are verv far from coextensive. Even Leibnitz was aware of the
existence of what he called '' obscure perceptions,*' i.e, affections of the mind,
which, betraying their reality in their effects, are themselves out of apper-
ception. Consciousness can give no account of the material conditions which
underlie every mental manifestation, or of those conditions of body to which
80 large a portion of our mental changes are wholly or in part to be referred.

To give mental science its proper place among the positive sciences, it
must be based, as they are, on the study of external nature. The external
phenomena from which the laws of mind must be inductively drawn may be
classed as — 1. The physiology of the nervous system. 2. The facts of the
degeneration of mind, as exhibited in the different forms of idiocy and
iosanitj. 3. The course of development of mind as exhibited in the suc-
cessive stages of the infant, the animal, and the barbarian. 4. The progress
or regress of the human mind as exhibited in history. Our object should be
to interest the mind in the realities which surround us, and to bring the mind
into harmony with the laws of nature. The mind that is in intimate sym-
pathy with the course of events is strong with the strength of nature, and is
developed by its force. Power is acquired by the habit of submitting the
understanding to things. Natural gifts sharpened by mere logical traming
are not enough without a large experience of life and men.

The very first thing necessary for the student of mental science is to form
a just conception of what is meant by mind. The metaphysical conception
of it as a peculiar entity, the laws of which can be known in a way peculiar
to themselves, must be discarded. Upon this abstraction, an imaginary
substance, the supposed source of power and self-sufficient cause of causes,
have been built all the endless and contradictory systems of philosophy. On
the other hand, the crude proposition of Cabanis, that the brain secretes
thought as the liver secretes bile, is not a true expression of the facts. Mind
may best be described as a natural force or energy manifested to us only
through certain changes in matter. As there are different kinds of matter,
so there are different modes of force in the universe. We rise from mere
physical matter, in which physical laws hold sway, up to chemical matter and
chemical forces, and from chemical matter again up to living matter ; so we
rise in the scale of life from the lowest kind of living matter up to the highest
kind with which we are acquainted — namely, nerve tissue, with its correspon-
ding nerve force. The hignest development of force is necessarily the most
dependent, as to its existence all the lower natural forces are indispensably
requisite. All exaltation of force is a concentration of it. As one equivalent
of chemical force corresponds to several equivalents of inferior force, and
one equivalent of vital force to several equivalents of chemical force, so in
the scale of tissues the higher kind represents a more complex constitution
and a greater number of simultaneously acting forces than the kind of
tissue below it in dignity. The highest energy in nature implicitly contains
all the lower kinds of energy. The idea of organization is therefore necessary
to the interpretation of every manifestation of life. The mind implies a
plastic power ministering to a complex process of organization during which
what is suited to development is assimilated, what is unsuitable is rejected.
Looking at man as a small and subordinate part of a vast and harmonious
whole, the history of mankind is the history of the latest organic development
of nature. In the evolution of the human mind nature is undergoing
its consummate development. The law of this development is the law of
progressive specialization and increasing complexity.

As with the term '* mind," so with that of ** idea." It has been converted
by the metaphysicians into an entity. A general term, summing up a great

258 Notes and News, [J^y>

number of varied phenomena, has been supposed to denote an object having
uniform and constant properties. The so-called fundamental ideas or cate-
gories of the understanding, which make so large a figure in systems, have
Dv Jio means a permanent value, quantitative or qualitative. They have no
absolute truth as expressions of certain fundamental relations between man
and nature. The formation of an idea is an organic evolution in the appro-
priate nervous centres, a development which is gradually completed in con-
sequence of successive experiences of a like kind. The cells of the cerebral
ffanglia idealize the sensory perceptions ; graspins that which is essential in
uem, and suppressing or rejecting the unessentisi, they mould them by their
plastic faculty into the organic unity of an idea.

In treating the emotions, it would appear that little new light is to be

Sained from i>hysiological observation. We arc compelled to assume a
elicate organization of the nervous structure on which emotion defends,
though by reason of the imperfection of our means of investigation, we are
not yet able to trace a process of such delicacy in those inmost recesses to
which our senses have as yet not gained access. Meanwhile " Spinoza's
admirable account of the passions, which has never yet been surpassed, and
certainly will not easily be surpassed/' may be adopted — a concession to the
old psychology for which we were hardly prepared after the denunciations of
it with which the author commenced. The general relation of emotions to
ideas, which they equal in number and variety, and the building up of
character by the association of emotions, pleasurable or painful, with ^iven
thoughts, is precisely the same as has been long given by the established
psychology.

We come next to volition. Here we are again cautioned to dismiss from
our minds the metaphysical conception of will as a fixed and undecomposable
entity of uniform power. Under the category of voluntary acts are really
included very various kinds of actions proceeding from different nervous
centres. There is no such thing as an ideal will, unaffected by physical
conditions, existing apart from particular concrete voluntary acts. What
we call will is the final reaction after deliberation, and, like other modes of
reaction of nerve element, is a resultant of molecular change in some one
nervous centre. It is true that each act of will contains a conception of the
end desired; this conception of the result, or design, constituting tne essential
character of the particular volition. But the design itself is a physical
necessity, being a consequence of cerebral adaptation to the varieties of
external impression. So far from the design manifest in a mental act evincing
a power which transcends or anticipates experience, it is one which conforms
entirely to experience. The more cultivated the mind and the more varied
the experience, the better developed is the will, and the stronger its co-
ordinating power over the thoughts, feelings, and actions. The will is no
despot ; it is ever most obedient where it has most power ; it conquers by
obeying. The history of a man is the revelation of his character. What he
has done indicates what he has willed. What he has willed marks what he
has thought and felt ; and what he has thought and felt has been the result
of his nature as the developed product of an original constitution plus a life
experience. The will is the highest force in nature, the last consummate
blossom of all her marvellous em)rts. It represents the exquisitely adapted
reaction of man to the best insight into the relations in which he moves. It
is by the power of a well- fashioned will that a man reacts with intelligent
success upon the external world, brings himself into complete harmony with
his surroundings, assimilates and incorporates nature, and thus carries
forward its organic evolution.

Neither in tne chapter on volition, nor in that on memory, will any details
be found which differ from what is usually delivered under those heads in the

1867.] Notes and News, 259

standard treatises of mental philosophy. The merit of Dr. Maudsley's work
does not lie in its parts, but m the grouping of the whole, and the reference
of each department to a few proper principles — the substitution, in fact, of
known physiological laws for the arbitrary dicta of so-called consciousness.
This is true not only of the first part of the volume, which treats of the
normal development of mind, but also of the second half, in which the subject
is degeneration of mind. Indeed so much has been written on insanity that
what is wanted here is arrangement rather than fresh observation, and the
application of ascertained principles of biology. Facts and cases have been
accumulated in enormous numbers, and have outgrown theory; or rather
theories have not been wanting, but they have been hasty, partial, empirical.
What has been had in view has naturally been treatment of patients. While
curative treatment has been slowly advancing to perfection, theory has been
left to take its chance.

In saying that curative treatment of the insane is carried to perfection, it
will of course be understood that the system, and not the practice, is intended.
The principles of treatment are well understood by the medical profession,
but special difficulties exist in the way of bringing the knowledge thus
possessed to bear on the patient in this class of disorders which do not exist
in other branches of practice. These difficulties consist chiefly in the fact
that the insane patient cannot be treated, like other patients, in his own
bome, but must, it is thought, be removed to an institution. Great indeed
has been the improvement in the management of asylums in this country
since Tuke directed attention to the barbarities of the old system. But
these institutions, generally speaking, are still far from being all that could
be wished, or what they might be made. Laws hastily passed under the
influence of popular panic and newspaper philanthropy thwart the medical
officer at every step. The country is covered with overgrown and over-
crowded asylums, into which the whole lunatic population is densely packed,
so as to defy classification. The timely treatment of the early stages of the
disease is rendered impossible. Our lunacy legislation is but one of the many
costly failures of Parliamentary Government. The preposterous attempt of
a miscellaneous assemblage of 658 gentlemen to make regulations for anything
and everything is here, as in so many other departments of the public service,
a fruitful cause of confusion, and obstacle to improvement. Dr. Maudsley
u an advocate for private treatment, where possible. On the same principle
on which we have gone great lengths in abolishing restraint within asylums,
he contends that we should go on to abolish the restraint of asylums in
the many cases to which such treatment is applicable. He quotes tne report
of the Scottish Commissioners in Lunacy on the condition of the pauper
insane in private dwellings in Scotland. A few .years ago these poor
creatures were in a wretched condition, either of neglect or ill-usage. Now
all is changed. By the agency of official instruction and inspection, sys-
tematically exercised, all who have to do with them have been penetrated
with more enlightened views. The condition of their charges now leaves
little to be desired. The former evils sprang not so much out of deliberate
cruelty, as out of want of knowledge on the part of those who had concern
in them.

We have not space to follow, even in outline, Dr. Maudsley's arrangement
of the pathology of mind. It is a most judicious summary of well-established
principles, illustrated without being overloaded by cases. The essay on the
Causes of Insanity (part ii, c. 1) has an interest far beyond professional circles
or philosophical students. It is a moral study, containing practical truths of
most serious import to all who live within the vortex of the social influences
of modem civilization. A steady increase in the number of cases of insanity.

an increase which for England and Wales alone is at the rate of one thoosana

260 Notes and News. [July,

a year, is far more than proportionate to the general increase of population,
and is not sufficiently accounted for by the fact that more people are now
declared mad than used to be so formerly. Dr. Maudsley proceeds, in pages
(200-258) marked by cautious statement and the stamper a wide experience,
to trace the causes of this increase to the varied excitements of English life.
We should like to see the whole of the chapter " On the Causes of Cisanity"
reprinted by itself in a cheap form for wider circulation. — Tke Saiurday
MevisWi May 25 th.

Was Luther Mad?

In the recent trial,* in which the validity of the will of Mr8.)Thwaites was
disputed, because of the extreme religious delusions which she was proved to
have had for many years, Mr. Serjeant Ballantine elicited from Dr. Williams

* MeUgioua hallucinations. — Whatever be the issue of the singular will case
which has been occupying the attention of the Court of Probate for so many days,
it may possibly contribute some little towards the settlement of the unsatisfactory
state of English law as to the condition of mind which constitutes what is termed
" testamentary incapacity." The arguments against the validity of Mrs. Thwaites's
will raise, in fact, one of the most diflScult psychological and social problems that
can be imagined. Did the religious hallucinations under which she laboured con-
stitute real legal insanity ? And if she was really insane, is there any truth in
the theory of one of the doctors who were examined, who held that a person may
be mad on religious subjects, and yet perfectly sane upon all others ? There is
also a still further question involved. Ought all insanity, as such, necessarily to
incapacitate a person from disposing of his property by will ? And then there is
the practical question, what constitutes a religious hallucination so entirely a delu-
sion that it may be held to be the product of a disordered mind, and yet at the
same time be compatible with practical sanity on all secular matters ? Or, to
state the difficulty irom another point of view, is it possible to be mad on reli-
gious topics without suffering from disease of the brain, either organic or func-
tional ? To answer these questions, even in the most hesitating way, would be, of
course, impossible in the space of a paragraph. But it may be useful to suggest
one or two of the difficulties which surround the subject, from whichever point of
it is approached. Insanity, says modem pathology, is a disease of the brain; but
in many cases how do we know that the brain really is diseased, except from the
occurrence of certain mental phenomena, which may, after all, be the result of
mere defective processess of reasoning, having no connection whatever with phy-
sical disease P In such pases we are driven to argue in a circle. Such and such a
man is not responsible for his actions, and is incapable of making a legal will,
because his brain is disordered. But how do we know his brain is disordered ?
Because his acts are inconsistent with the laws of reasoning. But is everybody
who cannot reason to be held legally insane? No; only when the brain is dis-
eased. But how do we know this in the one case before us ? and so on, round
and round without end. The truth is that, especially in religious subjects, we
have often no recognised tests as to what constitutes insanity. For instance, sup-
posing that a will was found to contain a clause for providing a proper personal
reception^ in the way of house, attendants, and ceremonial for the Founder of
Christianity on his appearing in London on such and such a date, would any jury
hesitate to hold this provision a conclusive proof of the testator's madness p Tet
how would this provision differ from the practice of the Irvingite body, who at
one time made preparations in their churches for the possible appearance of Jesus
Christ among them ? They may do it still, for all we know. They certfunly
practised the " speaking in unknown tongues," under the belief of being personal
instruments of the Holy Ghost, until very recently. — Fall MaU QazetU,

1867.] Notes and Netos. 261

of Bethlem Hospital, in cross-examination, a confession of opinion that
Luther was mad, or, at any rate, not altogether sane. Dr. Wood is stated
in the newspaper reports to have given similar evidence. Whatever we may
think of their opinion, we must admire the rare candour of these physicians ;
for the admission was anything but calculated to serve the cause in the de-
fence of which they were called.

But was Luther mad ? The spiritual temptations which he underwent he
described as huffetings of Satan ; with these he was frequently tormented ;
be called them conflicts between him and Satan. The terrors he experienced
be called the devil's traps, from which he earnestly prated God to deliver him.
If this were madness, then every preacher who describes the evil impulses of
the heart as the instigations of Satan is surely mad himself, and teacnes mad-
ness to his hearers; and that, too, without the excuse which Luther had in
the iguorance and superstitious credulity of the times in which he lived.
The manner in which Luther himself spenKs of his temptations is interesting,
for it resembles the way in which he speaks of insanity. '* I think," he says,
" that all fools, and such as have not the use of reason, are vexed or led aside
by Satan ; not that they are therefore condemned, but because Satan doth
diversely tempt men, some grievously, some easily ; some a longer, some a
shorter time. And whereas physicians attribute much to natural means
sometimes, this cometh to pass because they know not how great the power
and the strength of the devils are." This, though it lack form a little,
according to modern scientic ideas of insanity, is ^* not like madness."

But let us go on to hear how he speaks of his conversations with the devil,
whose persecutions cost him many a bitter night — multus nodes mihi satis
amarulentas et acerbas reddere ille novit. '* The devil," he says, " knows how
to invent, and to urge his arguments with great force. He also speaks in a
deep and loud-tone voice. Nor are these disputes carried on in a long
course of various argumentaticm ; but the question is put, and the answer
given, in a moment. I am sensible, and have sufficiently experienced, how
It sometimes happens that persons are found dead in their beds in a morning.
He is not only able to kill or strangle the body, but knows how to urge and
close in the soul with his disputations, that it is obliged to quit the body in
an instant — a state into which he had nearly reduced me more than once.
For no mortal can endure and withstand them, without the peculiar assist-
ance and power of God."

With tuis compare what Whitfield says in his journal, about whom a re-
port was once raised that he was mad, and who says of himself that " he
might very well be taken to be really mad, and that his relations counted his
life madness." '' One morning, rising from my bed, I felt an unsual impres-
sion and weight upon my chest. In a short time, the load gradually increased
and almost weighed me down, and fully convinced me that Satan had as real
possession of mv body as once of Job's. ... I fancied myself like a
man locked up m iron armour ; I felt great heavings in my body ; prayed
under the weight till the sweat came. Bow many nights did I lie groaning
under the weight, bidding Satan depart from me in the name of Jesus."

If these earnest men were mad, then how far gone in madness must the
psalmist have been when he cried out, " Many oxen are come about me ; fat
Dulls of Basan close me in on every side." Hallucinations these, surely, of
an extreme kind. Which of the great prophetic writers of the Bible will
escape the suspicion of insanity, if a vehement sincerity of nature, an ex-
alted imagination, and burning words of passionate earnestness taking a
figurative expression, are to be deemed indications of mental unsoundness P

It cannot be questioned that Luther was of a vehement nature, intensely
earnest, ardently imaginative, obstinate even to rashness, as a man fighting
the battle which he fought had need to be. By an incessant application to

262 Note9 and News.

v--

study, and by a sedentary life, he had greatly injured his health, so that he
actually heard the noise " which the devil made to torment him ;*' and on
one occasion he was certainly cured by exercise and medicines sent him by
Spalatinus. Notwithstanding these things we are of opinion that any one
who engages to prove him insane, wrongly measuring the style and habit of
thought of one ase by those of another age, will have to make use of argu-
ments which, if they were worthy anything, would prove most of the great
and earnest reformers whom the world has seen to have been insane also.
Was not Socrates mad, in whose ears a demon constantly whispered what he
should do ? Numa could not have been of sound mind, inasmuch as a certain
nymph, whom he called Egeria, appeared to him in a cavern. Would not
such an acknowledgment be a decisive ''fact" in any medical certificate?
Was Mahomet sane, to whom an angel called Oabriel paid regular visits ?
We say nothing of George Fox ; or of Ignatius Lovola, that *' errant,
shatter-brained, visionary fanatic." Of Oliver Cromwelrs grievous madness
some minds will entertain no doubt. Did not a spectre appear to him in the
open day ; and a strange woman open the curtams of his bed at night, to
predict to him that he should be King of England ? Moreover, he was sub-
ject to uncontrollable fits of laughter on serious occasions. " One that was
at the battle of Dunbar," says Aubrey, '' told me that Oliver was carried on
by a divine impulse. He did lau^h so .excessively, as if he had been drunk.
The same fit of laughter seized him just before the battle of Naseby." But
we must make an end of instances, which might be multiplied indefinitely.

It may be well to conclude by suggesting for consideration this question,
not whether some touch of madness may not be detected in every great
genius, but whether, under the system of indiscriminate sequestration of the
msane at present in fashion, some ^reat genius, having a slight touch of mad-
ness, is not unnecessarily ending his days in an asylum. Can any one, after
reading the autobiography of Benvenuto Cellini, doubt that, if that ffreat
artist had lived now, instead of three hundred years affo, he would nave
lived and died in a lunatic asylum, and that thus the world would have been
defrauded of the best fruits of his genius ? — British Medical Journal, May IS.

Recent Contributions to Mental Philosophy,*

(See * Journal of Mental Science,' October, 1866.)

The Nature of Things is a great subject, and one that solicits oar atten-
tion in many forms.

It has happened to many of our readers to look into a shop, attracted bv
some article m the window, with the desire of buying one or two for trial,
and to be met with the answer. Sir I we do not sell less than a dozen. It
may be supposed that we have taken up this plan with respect to works in

* 1. ' Essays for the Times on Ecclesiastical and Social Subjects.' By J. H.
Bigg, D.D. (Stock.) — 2. < Faith and Philosophy. Essays on some Tendencies of
the Day.' By the Rev. J. Gregory Smith. (Longmans and Co.) — 3. * The Com-
mandments considered as Instruments of National Reformation.' By F. D.
Maurice. (Macmillan and Co.)-— 4. 'Benedicite; or, the Song of the Three
ChUdren.* By G. Chaplin Child, M.D. 2 vols. (Murray.)— 5. • The Rise and the
Fall; or, the Origin of Modern Evil.' (Low and Co.)--6. 'Lectures on Qredi
Philosophy ; and other Philosophical Remains of J. F. Ferrier.' 2 vols. (Black-
wood and Sons.) — 7. 'The Philosophy of the Conditioned: comprising some
Remarks on Sir W. Hamilton's Philosophy, and on Mr. J. S. Mill's SzaminatieB

1867.] NoteB and News. 263

which psychology is predominant ; and, after a sort, there is truth in the
supposition. There is one important difference between us and our quar-
terly contemporaries : we deal more with books ; they deal more with sub-
jects. The treatises on branches of philosophy, or on the philosophy of
branches, which pour from the press, cannot be dealt with subject by sub-
ject. Our contemporaries above mentioned, who may choose their books,
and who may leave nine books out of ten unmentioned, may suit their own
convenience, and need not fatigue their readers. But we are pledged to say.
something about every thoughtful production : and if we were to discuss
every one, the nature of things would never be off our anvil. Works on
this great subject pour from the press like novels, or rather as novels used
to pour ; for our fictions are now published piecemeal. It is not yet the
fashion to administer deep psychology in weekly or monthly doses ; but if the
craving for philosophy should grow as it has grown, to such complexion — or
complication — we may come at last. We now proceed to our authors.

1. Dr. Rigg's essays were — all but one — reviews. To join the words

would have a twang of heresy : even Essays alone savours of the rational.

So we have Essays for the Times ; and the little reminiscences of old Trac-

tarianism which linger about the second word neutralise the effect of the

first word. Dr. Kigg is a Methodist, and his articles show that his sect is

on the way to become very decidedly literary. The old spirit of Methodism

b shown in an anecdote which we heard from a trustworthy source. A man

of culture was talking to a Methodist preacher of the very ignorant class

about his vocation. Have you never considered, said the scholar, that your

religion was delivered in a foreign language, that the books are to be selected

and authenticated, that the text, the translation, and the interpretation, are

all matters of critical thought ? &c. Lord I Sir, was the answer, what has

all that do with salvation ? To which the rejoinder should have been, Here

is a question not answered in a moment, and one which eminently requires a

clergy of moderate learning.

Dr. Kiff^s papers on the Clergy, the Church, the predecessors of the
Wesleys, Kingsley and Newman, rusey's * Eirenicon,' Manning and Pusey
in their relations to schismatics, heterodox speculation, the Bible, pauperism,
and education — are all readable, and something more. They are refreshing
after the quantity of dogmatism which proceeds from quarters in which
peculiar spiritual endowments are claimed under cover of peculiar temporal
endowments. Not intending to review reviews, we turn to the matter of
most interest which is new. It is a prefix of a few pages upon the character
of Methodism. In answer to the wide-spread impression that Methodists
are only just separated from the Establishment, and might be reunited
without great difficulty. Dr. Bigg declares that there is not the remotest pos-
sibility of this absorption. He doubts if among all these hundreds of thou-
sands there be a score of Methodists who would not smile at the proposal.
He joins a distinguished colleague, the Bev. W. Arthur, who wrote ten years
ago on the Very point, in declaring that such a union would imply a sacrifice
On the part of Methodism of its claim to be a Church, on the part of its

of that Philosophy/ By H. L. Mansel, B.D. (Strahan.)— 8. 'Inquisitio Philo-
sophica ; an Examination of the Principles of Kant and Hamilton.' By M. P. W.
Bolton. (Chapman and Hall.)— 9. * The Beign of Law.' By the Duke of Argyll.
(Strahan.)— 10. *The Elements of Deductive Logic' By T. Fowler, M.A.
(Clarendon Press.) — 11. * The Logic of Chance : an Essay on the Foundations and.
Province of the Theory of Probability, with Especial Keference to its Application
to Morftl and Social Science.' By John Venn, M.A. (Macmillan and Co.) —
12. * The Elements of Molecular Mechanics.' By Joseph Bayma, S.J. (Macmillan
and Co.)

264 Notes and News, [July,

clergy of their character as ordained ministers of Christ, and on the part of
its adherents of all that is distinctive in its organisation, and of its highest
and most cherished principles — one of these being the position of sisterly
fellowship and evangelical communion in which it now stands towards all
other Protestants, whether at home or abroad, the Eitablished Church alone
excepted. This is clear : but Dr. Rigg does not make it clear that it has
always been so. On the contrary, he seems to us to show that there was,
while Wesley lived, only a "virtual" separation, which has gradually
widened. We do not doubt that Tractarianism and Ritualism have been
the instruments of bringing about that, in our day, *' the repugnance of
Wesleyan Methodists to join the Church of England is stronger than that of
Di.ssenter8." And yet, even now. Dr. Rigg does not say other Dissenters.

2. Mr. Gregory Smith's essays have also been published at different times
during the last ten years ; they are on various subjects of the day, and are
to reconcile the apparently, but not really, conflicting claims of faith and
reason. By properly distmguishing exceptional and ordinary confession,
ministerial and judicial absolution, spiritual and material presence, it is
hoped that, in spite of scepticism and fanaticism, it may be shown that there
is a deep and essential harmony between the English church and the English
nation. So we are to have a real presence, a confession, an absolution, —
but of the right sort. We strongly suspect that the English nation — the
bulk of its conformists and nonconformists — would give much the same
answer as the life-guardsman gave to Cuddie Headrigg's request to know
which covenant his mother was to renounce, " Any covenant ! All covenants
that ever were hatched." The English mind does nothing but carp at
Confession, Absolution, and Real Presence ; and we see we have an acrostic.
Leaving this, we turn to Mr. Gregory Smith, and we take a proposal of his —
and some others too — on the burial service. He would have a form of
''joyful confidence" for communicants, and one '* less expressive of hope and
joy" for those who are not communicants. Now, considering that the Pha-
risees, the self-righteous, the covetous, and the hypocrites, form at least
a good minority of the communicants, he must be a bold man, who, aiming
at truth, would venture our present service over all communicants, as a
thing which is to be held in doubt from all who are non-communicants. The
proposal is, for our English community, very like what the recently manu-
factured sinlessness of the Virgin is for the Romish Church, a thing born out
of due season. No such absurdity will ever be tolerated ; the present plan
is preferable : better to send all to heaven, than to attempt selection.

3. Prof. Maurice assigns a deep force of meaning to the Ten Command-
ments, claiming for them a more than Jewish character, treating them as the
great barriers against presbyterial and prelatical assumption, and declaring
" if we do not receive them as commandments of the Lord God spoken to
Israel, and spoken to every people under heaven now, we lose the greatest
witnesses we possess for the national morality and the civil freedom which
these assumptions are undermining." He objects to the omission from the
Church service of the reference to Egypt, assigning to all Christians an
Egypt out of which they have been brought. He disputes the Jud^ical
character of the reward for honour of parents, on the ground that all the
law possessed by man is given by God. In matters of pure morality he is
often strong and never weak ; but we think that in his mode of extending
the domain of Jewish law as Jewish, he is not so fortunate.

Mr. Maurice is always readable and readworthy; but we seldom look
into a writing of his without finding something very peculiar. We note one
passage, as showing what a pity it is that all students are not made to study
some elements of logic, were it only to learn the technical terms, which play
a part in almost all branches of knowledge:—

1867.] liote% and Kewi, 266

** What we mean by the divine attributes I never quite understood. But
if we ra^an what the word would seem to convey, that we * attribute' certain
qualities to God, then I say, that not only the Hebrew form of expression
does not answer very nearly to what we mean, but that it directly contradicts
vrhat we mean. 'The devout Hebrew believed that his nation was called out
of all nations to bear witness against those who attribute their thoughts to
God."

Mr. Maurice, a theologian, only knows the word attribute as a probable
importation from common language into theology. It is an old technical
term of logic, which in some systems — the famous rort- Royal, for example—
is the word used for predicate. When wo say, " God is omniscient," we, in
technical phrase, pronounce omniscience an attribute of God: when we say
" the rose is red," we pronounce redness an attribute of the rose. It has
long been settled that we have not any knowledge of the substance of things ;
we only know attributes, or qualities. The theologians insist that we only
know God by attributes ; and often speak as if we knew more of other
things. The consequence is that the old word has come to have, in common
use, a special reference to the Deity. A recent logical writer says that he
once heard a person, in mixed company, speak of the attributes of the vege-
table world. Some were inclined to impute irreverence; and some half sus-
pected that the speaker worshipped leeks and onions. " When we talk,"
says Mr. Maurice, *' of God's attributes, we assume, however unconsciously,
that our conceptions are the ground of his being." When we talk of the
attributes of a rose, we surely do not assume tliat our conceptions are the
grounds of its being. Mr. Maurice goes on to the following antithesis :
*^ When we fear His Name, we confess that his being is the ground of our
conceptions." We shall not attempt to ascertain how this is : we only remark
that Mr. Maurice, like some of his predecessors, has ideas about the Name
which seem to us somewhat mystical. Nevertheless, we think any devout
mind would be pleased with this book.

4. Babylon, the probable centre of Adam's garden, now desolate, was the
city in which Nebuchadnezzar tried to burn three young Jews : but his in-
tended victims took no harm from the fire, in which they quietly sang the
praise of God. There is a hymn, called the 'Song of the Ihree Children,'
which tradition has given to those young Jews : it is part of the English
prayer-book. But, as Dr. Child remarks, it is seldom sung, and is sometimes
even omitted from editions of the Common Prayer : but he calls it one of
the most suggestive and soul-stirring hymns in existence. To him no doubt,
it was both ; for it prompted him to write two volumes of comment. But
perhaps it is held rather monotonous. It is, " O ye . . . . bless ye the Lord :
praise him and magnify him for ever;" the blank being filled up in thirty-
two different ways, each way giving a verse. Thus, among other things,
showers and dew, fire and heat, night and day, whales, fowls, and beasts, are
instructed to bless God in this hymn of bidding praise. It is one poetical
idea, very fit to be the subject of a hymn, rendered prosaic by undue repeti-
tion. Dr. Child treats the verses in the most prosaic way possible ; he makes
each one the heading of a chapter on physics. Thus, since night and da^ are
to praise God, we are told that the earth revolves in 23h. 56m. 4s., giving
rise to day and night : the perfect working of the machine being evident
from Laplace's demonstration that the day cannot have varied a hundredth
of a second from the earliest ages until now. But it ought to have been
shown how this rotation contrives our day of twenty- four hours exactly.
And it is unfortunate that the perfect invariability of the day should be
brought forward in proof of perfection, at the very time when there appears
to be more than suspicion that a slow alteration has actually been in pro-
gress.

266 Note$ and Nem. [Jolyj

5. It is really too bad to write three hundred pages upon the origin of
evil. The author will have it that mau was not created holy, but only stain-
less, and without moral sense ; he acquired a moral sense by some aft repre-
sented as eating forbidden fruit ; he thus became— not sinful but — capable
of sin ; and of course — we know him — began to sin immediately. How eating
fruit ** forbidden*' by a competent authority should awaken moral sense we
cannot understand, any more than how it should be anything but wrong.
We once knew a young gentleman who, by interest, was admitted a mason
when much under age : he wrote down all they told him on a paper, which
he lost. He was in a dreadful fright, thinking the Masons would put him
to death ; but a friend of the craft to whom he confided his fears laushed
and said, *' Nonsense ! if any one should find the paper he would not believe
it." We are in much the same position with respect to the origin of evil : if
the true solution were to be found, no one would know it.

6. The first volume of Mr. Ferrier's remains consists of his lectures on
Greek philosophy: the second is nearlv all devoted to reprints of his
articles in * Blackwood.' His colleague, iProf. Veitch, says of him, " Meta-
physic was his delight and his strength. The problem of Being, what it is ;
now to be analysed ; how made intelligible ; to get its principle and deduce
its form." He took, we are told, little interest in psychology or in logic ;
and had read but slightly in either. By the Powers 1 — we were going to
say, but we check ourselves and substitute. By the weaknesses ! — thmk of a
man like Ferrier, who had a real head, setting to work upon Being, as Being :
and this with little attention to the phenomena of mind or the laws of
thought. To answer the question, What is IS ? To settle how the possi-
bility of such a question arises ! Pure ontology is the cyclometry of psy-
chology : we do not object to it ; for in like manner as attempts to square
the circle were very fruitful of better things in days gone by, so much good
result is now produced from time to time by cracking the teeth upon the
nut of pure bein^. Mr. Ferrier was a very able artist in this line ; but,
though he has leu good exercises of severe thought, yet he makes it clear
that he is in a state of hopeless belief in his own power to demonstrate exist-
tence, to account for it, and to deduce all things from it. But this chiefly in
his work on metaphysics ; in the volumes before us he comes down into our
sphere, and is accessible to men of limited aspirations. A thoughtful reader
is sure to be pleased and instructed.

7. Mr. Mansel begins by inverting Plato, who employs hypotheses, as
steps, one upon another, and so descends {Karafiaivti) to the unsupported
(dvvirodirov). ^ By using the word unconditioned and making Plato ascend^
Mr. Mansel gives a turn which might have escaped notice, if he had not
added the Greek word, and so made Plato seem to go up to the founda-
tion. Mr. Mansel, over and above his task of remarking on Mr. John Mill,
has to answer a little cloud of opponents. His name has become a word to
signify the maintenance of the opinion that man can know nothing of Grod,
and we have always held that he has been quite misunderstood, and unfairly
treated. The crowd has confounded knowledge of God's nature deduced from
thought and phenomena with knowledge deduced from premises furnished
by God himself: and has made Mr. Mansel deny both in denying the first. His
answer is not difficult : he can call spirits from the vasty deep, and they do come
when he doth call for them. Accordingly, he charges at the head of Chrysostom,
Basil, Gregory Nazianzen, the Cyrils of Jerusalem and Alexandria, Augustine,
Damascenus, Aquinas, Hooker, Usher, Leigh ton, Pearson, Beveridge, and
Leslie — who all express opinions similar to his own — and drives his oppo-
nents from their position. Perhaps, since Mr. Mansel was arguing with
theologians, one reference — say Job xi, 7 — might have settled the matter:
but the fathers have spells of wonderful potency. To give any further

1867.] Notes and News. 267

account of the work would require us to open the whole question between
Mill and Hamilton.

8. Mr. Bolton's work will repay those who have so much learning that they
can run it over with ease, and tnose who have so little that they would be glad
to pick up miscellaneous knowledge in little time. Moreover we must say that
we read with pleasure ; but the convolutions become very much involved
before we come to the end. What does Kant say ? What does Hamilton
say Kant sajs? What does Mill say Hamilton says Kant says? What
does the reviewer say Mill says Hamilton says Kant says? What does Mr.
Bolton say the reviewer says Mill says Hamilton says Kant says ? It is the
house that Jack built ; it is the gaping, wide-mouthed, waddling frog. This
is too much the tendency of our time : it is the earth on the elephant which
is on the tortoise, &c. This concatenation is very perplexing ; beyond all
question a full account of Mr. Bolton would require us to go from him to
Kant through all the series. There is nothing like it anywhere else.

9. The personal reputation no less than the rank of the Duke of Argyll
has drawn much attention to his work ; and the perusal will increase the
respect paid to both. The author is a true observer of nature in the field,
in the museum, and in the book of description : he is also given to thought
on creation and final cause. He is not very deep in mechanical science, as
is proved by his reproduction of the old distinction of centripetal and cen-
trifugal force in its old confusion. The work is on law ; on the distinction
of natural and supernatural, well illustrated ; on law in difiTerent forms of
action, material, mental, social ; on contrivance and creation ; plenty to agree
with ; plenty to differ from ; nothing to be tired of. There is freedom of
judgment in new matters, but not equal freedom in old ones. The Duke
calls it mere idle play on words to explain thought by calling it cerebration,
and to say that the laws of intellect are reduced to scientific expression when
they are described as the working of the cerebral ganglia. Not a doubt about
it : but there are various verbal transformations, sanctioned by usage, — to
which he might equally object, but which nevertheless he employs without
remark. From a person who thinks that he will explain thought, whether
ganglionically or otherwise, and from a person who thinks he can explain the
growth of a plant, we turn with equal despair of instruction. The action
of the earth, air, and water producing leaves of one type on every branch,
and seeds which are ready to repeat the process, — the action of the ganglia
producing at last a full conviction that the middle term in a syllogism must
not be ambiguous, — are things equally obscure. We derive as much ex-
planation from either as from the description given of the engine on board
the steamer by the scientific gentleman with the return ticket to Gravesend.
** Sir ! you see that thing which moves backwards and forwards ; well, sir 1
that is the hydrostatic principle, which is worked by trigonometry I" The
lady and gentleman to whom this view was addressed exclaimed, ** How
beautiful things are when they are explained I" The difference of our cases
is this : relations of precedent and consequent, relations of analogy between
phenomena, abound in botany : not one have we got in the ganglionic theory
of thought. Let the promoters of this last speculation range animals in
order of power on some one point, sa^ inductive generalisation ; let them
show a chain of alterations in ganglionic phenomena, increasing in manifes-
tation as we go up the chain of animals — and we shall then have one case
resembling those of which scores are known in the physiology of plants.
The time may come when this shall be done ; but not a bit nearer shall we
be to the explanation of thought.

10. Mr. Fowler's book is one of the Clarendon Press series. It is not
overloaded, and tlie explanations are clear. Some approximation to modern
views is made ; but on the whole, the matter does not go much beyond

2d8 ifoUs and N'ews, [July^

Aldrich. TecLuicul terms are kept in due subordination to common language.
Accordingly, though the work be intended fur a University class-book, it will
do perfectly well tor a self-teaching student in the wide world ; and, of all
booKS equally good, it is the shortest.

1 1 . Mr. Venn's work on the loffic of chance is rather a misnomer ; for,
the meaning of the word once settled, he and his opponents agree in mode
of deduction. There are two views of probability ; the subjective, and the
objective. In the subjective view, the word really means brief: and the
questions which arise are such as this : If I have this degree of belief in
event A, and that degree of belief in event B, what d^ree of belief ought
I to feel that both will happen ? In the objective view, the notion is derived
from the hn^ ruut from the state of the cases : and the question is, if such a
fraction of possible events contain A, and such another fraction contain B,
what fraction will contain both A and B ? Mr. Venn favours the second
view, the material he calls it ; in opposition to the first or concepiualis view.
But we should be afraid, without reiterated examination and long descrip-
tion, to state his theory with attempt at precision : he is too long, and is not
given to distinct summary ; the nearest approach is in the ' Table of Con-
tents.* For ourselves, we admit both views, each in its proper place, and in
proper connection : and of course we do not agree with Mr. Venn in his
contrasts and his oppositions. His book is one more attempt to put the sub-
jective at war with the objective, and to make one destroy the other. No
such attempt will succeed. Time and space will be both, in spite of Kant ;
chance will be both, in spite of Mr. Venn.

12. Dr. Bayma is a Jesuit employed at Stonyhurst. He has shown him-
self by previous publication, profoundly versed in the old philosophy : and
he has given, in a paper on his subject in the Monthly Notices of the Royal
Society, plenty of proof that he is a profound mathematician. He now gives
a more extenaed view of his theory, which is nothing less than an attempt
to deduce chemistry from molecular action, the shapes of the molecules hav-
iiig A great deal to do with the matter. We might be able to pronounce an
opinion after a few months of study, or we might not : but beyond doubt we
shall not attempt to judge as we are. The molecular theory is, most surely,
destined to be a great branch of human knowledge ; but it may be doubted
whether the contemporaries of its Newton, when he shall appear, will know
what manner of prophet has arisen.

And thus we end our list. We only aim at giving our readers an aperfu^
as the French say, which may make one or another think that the book he
wants is perhaps within his reach. In the meanwhile, the harvest is growing.
— 2%tf Athenaum,

A Chancery Lunatic.

The admirers of Mr. Reade's novels are familiar with the opinion which he
holds, that the law of lunacy is systematically made an instrument of oppres*
sion and wrong. Indeed, it would appear that this opinion is not held by
Mr. Reade exclusively. There is, or was, in existence a Lunatic's Protection
Society, which was got up by a gentleman who had been confined, as he con-
sidered, wrongfully in an asylum. Cases constantly occur in which it is
alleged, not only by lunatics, but by some of their friends, that restraint is
cruel and unnecessary. Evidence is usually forthcoming in such cases that
the person so restrained is, in the opinion of the deponents, rational and in-
offensive, and, in fact, a person whom it would be rather pleasant than
otherwise to have for an inmate of one*s house. Such evidence may, at the

1867.] Notes and News. 269

time it is given, be difficult to explain or contradict, but it has happened
before now that lunatics have become convinced of that lunacy which their
friends have doubted, and have voluntarily returned to the very condition of
restraint from which well-intended, but mistaken, eiforts have delivered
them.

The story of a protracted case of lunacy may almost always be told in two
ways, and it may be interesting to take a case which lately came before the
Court of Chancery, and look at it first from the popular and sentimental, and
afterwards from the legal point of view. Assummg as much as we can of
the mental attitude of the sensation novelist, we will begin by stating that
Mr. James Tovey, now aged 38 years, was educated at Eton and Oxford,
and afterwards at St. Bees* College, being destined for holy orders. In 1853
Mr. Tovey, being then 24 years of age, was residing for the vacation at Deal,
where he formed an attachment to a young German lady. His father,
Colonel Tovey, hearing of this affair, ordered him to London, and shortly
afterwards placed him in a lunatic asylum in Epping Forest, where he
remained upwards of three years. Whether he at that time showed lunacy
only by falling in love with the young German lady, or by other and what
signs, we are not informed. In 1856 he was removed to another asylum
near Stafford, which is managed by Dr. Hewson, and he remained there
about five years. Early in 1862 the trustees appointed by his father, who
was now dead, acting under eminent advice, caused him to be removed to
the private residence of a surgeon at Dover, where he enjoyed free exercise
in the open air. After a year's trial of this mode of life it* was considered
expedient to relieve him from all restraint, and to allow him to reside with
his sister, who, after occupying one or two temporary abodea, went to live
in October, 1863, at Goring, in Oxfordshire. The life which he was permitted
to lead at Goring seems to have agreed with him very well. He was almost
constantly rowing on the Thames, which Hows past the village, and he was
very active in skating and swimming during the appropriate seasons. The
inhabitants of Goring and the adjacent villages have testified that Mr.
Tovey's conduct while he dwelt among them was quiet, harmless, and,
according to their judgment, sane; and there seems to have been no reason
why Mr. Tovey should not have been dwelling among them still, but, un-
happily for this poor gentleman, his uncle died last year, and he succeeded
Jo a large fortune, which caused the Court of Chancery to take an increased
interest in the disposition of his person and estate. On the 24th of February,
1866, Mr. Tovey was taken to the asylum kept by Dr. Hewson, near Stafford,
'vliere he had been confined before. On the 4th of March following his
Uncle died, and he became entitled to what may be called, in a new sense,
damnosa hareditas in the shape of an entailed estate amounting to about
^2000 a year, and a sum of £60,000, which had been accumulating for the
Purchase of other estates. On the 4th of May a Commission of Lunacy was
held at the asylum, by a Commissioner, without a jury, and without the
presence of any lawyer on behalf of Mr. Tovey, and he was found a lunatic.
But the strangest part of this story is jet to come. On July 28th Dr.
Hewson took a number of his patients, among whom was Mr. Tovey, to
Bcarborough, for the benefit of sea-air and bathing. He was allowed to
wander at his will all day, giving a promise to return at night. During his
wanderings he met a lady. First he looked, next he raised his hat, and then
he spoke. The lady did not repulse this overture, and why should she ?
Many flirtations, producing some marriages, arise at Scarborough; and if there
is to be no beginning, it must be impossible to reach the desirable end. We
believe that the correct thing is for the gentleman who seeks the introduction
to make acauaintance with the lady's brother or other male friend, which may
be done while bathing, or by offering or asking a light for a cigar. But if the

VOL. XII7. 19

270 Notes and News. [JiilVj

lady has only female friends it would seem that her admirer must keep his
admiration to himself, and see her complete her month's visit, and depart with-
out haying told his love, unless she should happen to drop her glove upon the
esplanade, or meet with some other accident which may justify iuterpositioo
on her behalf without the previous ceremony of introduction. It appears
that in the case under consideration the lady had a brother; so, if Mr. Tovey
had been patient, he might have attained his object with strict regard to
conventionality. But Mr. Tovey was not patient. He spoke to the lady,
and she did not refuse to listen. But we know that little sins lead to great
sins, and accordingly this lady, who had been less regardful than she should
have been of the conventional etiquette of Scarborough, did not hesitate, a
few days afterwards, to commit a contempt of the Court of Chancery. If a
young woman does not fear either Mrs. Grundy or the Lords Justices, she is
not likely to regard anything that we may say, and therefore we will say
nothing. But the beginning having been made, Mr. jtovey proceeded
rapidly to the end. He explained fully his position, and stated frankly that
he wanted somebody who would take an interest in him and see him righted.
The lady did not find that he was mad, but, on the contrary, thought him a
very nice young man. Her friends approved the step which she resolved to
take, and accordingly, on August 27, a marriage ceremony was performed
between her and Mr. Tovey at Claremont Chapel, Scarborough. The bride
and bridegroom spent the day together, but Mr. Tovey yielded to the obliga-
tion to return to his appointed place with the fidelity of the Ghost in Hamlet,
At 9 o'clock in the evening he rendered himself at Dr. Hewson's house, and
next day he was taken back to the asylum in Staifordshire, so that he saw
his bride no more. A secret correspondence was kept up between them for
some weeks, but it was afterwards discovered and stopped. The lad/s
friends, acting on the authority which the^ allege themselves to have received
from Mr. Tovey, have presented a petition to the Lord Chancellor asking-
that the finding of Mr. Tovey lunatic by commission may be superseded, or
at the least that his condition may be ameliorated by removing him from the^
asylum and restoringhim to that enjoyment of air and liberty which waa
allowed at Goring. They produce evidence of clergymen and other respect-
able persons among whom Mr. Tovey had dwelt upwards of two years to
prove that he is not mad at all, or, at any rate, that his madness is neither
dangerous nor disagreeable ; and they urge against restraint the arguments
which has often been urged before, that to put a man into a madhouse i»
enough to make him mad.

All readers will probably agree that they have now had lud before them
the outlines of a story excellently adapted for embellishment by an artist of
Mr. Readers school. Some readers are probably indignant at the treatment
which Mr. Tovey has undergone, and expect to be inK>rmed that the Court
of Chancery has ordered his release. But the Lords Justices, before whom
the petition came last week, not only did not accede to it, but testified a
strong inclination to do what may be figuratively described as wiping their
boots in it. And it is proper to say^ that the Court had good legal reasons
for what it did. The evidence of inhabitants of Goring as to Mr. Tovey's
sanitv was answered by the remark that there never was a disputed case in
w^ich such evidence was not forthcoming. Delusions may exist which nuiy
justify the imputation of insanity, and yet the alleged lunatic may mingle ia
social intercourse without betraying that he is possessed by them. The
Court, when called upon to decide between such evidence and that adduced
in support of a Commission, may either examine the lunatic itself or may
appoint for that purpose a physician of eminent skill who is above suspicion
of partiality. In. Mr. Tovey's case the latter course had been adopted, and
the Lords Justices stated that the physicians' report satbfied them ckf his

1867.] Notes and News, • 271

insanity. Whatever else may be said of the jurisdiction exercised over
lunatics in Chancery, it must be admitted that the distinguished judges wh»
exercise it are actuated by a conscientious desire to do right. They must
either proceed by the light of their own intelligence, or they must seek the
best assistance which the medical profession can supply. The popular belief
that what are called mad-doctors will prove anybody to be mad is not
destitute of foundation. But the Lords Justices can only take medical science
as they find it. There is, however, no difficulty in crediting the statement
that Mr. Tovey showed himself a month ago to be indisputably mad. The
only question is whether, if he was only disputably mad when he lived at
Goring, it might not be better that he should be allowed to live there again.
The technical answer to this question is that the committee of the lunatic's
person is the proper judge of matters relating to his health and comfort, and
unless it could be shown that the committee had misbehaved or was unworthy
of trust the Court would not interfere. A petition presented in the lunatic's^
name by friends of the lady who had ventured, in defiance of the Court, ta
go through a ceremony of marriage with him, was not, strictly speaking,
entitled to be heardv Such persons could have no proper loeus standi before
the Court. It was urged that, whoever asked for the lunatic's enlargementy
the Court ought to grant it in the hope, which experience showed to be well
founded, that his mental and bodily health would be improved. But the
Court answered that there was small encouragement to allow liberty, seeing
how it had been abused at Scarborough.

The conclusion of the Lords Justices is, from their point of view, irrefra-
gable ; but it may perhaps be permissible to draw attention to some con-
siderations which appear applicable to cases of this kind, although they are
not dreamt of in the philosophy of Lincoln's-inn. We will venture to ask.
whether that which was done at Scarborough was really so very shocking as
a Lord Justice thinks it ? May we be allowed, without disrespect, to hint
that possibly the lady before mentioned could manage Mr. Tovey better than
tiie Lord Chancellor and the Lords Justices, with the help of the Masters m
Lunaey, secretaries, and clerks ? It may be that for this purpose a bonnet
covers more true wisdom than any number of full-bottomed and other wig&
We have not before us the medical opinions given upon Mr. Tovey *s case,
and therefore we shall not presume to form any decisive judgment on it..
But we can easily suppose a case which is technically one of insanity ; but
which, under judicious management, might pass from the cradle to the grave
as one of eccentricity or infirmity of character. If a young gentleman who
is Bot very strong in the head falls in love with a young German lady who
plays seductively upon a cithern, and if the young lady is willing and the
yoaog gentleman's friends can afford to allow them a maintenance, by all
meana fet them marry ; and it is probable that during their joint lives the
world will hear nothing about lunacy in the gentleman. But parental
authority iBi;erposes and makes all the son's future life miserable. And
when the Other's control terminates by his death, the Court of Chancery
steps into his place, and, with the best intentions and acting upon established
rules, makes the son's last state more wretched than his first. The proceed-
ings in the matter of a lunatic who has a large estate are conducted with all
tlie solemn and cumbrous formality to which English lawyers are so devotedly
attached. Such proceedings are profitable to the practitioners ooncerne<^
and beneficial to the lunatic's heir-at-law and next of kin, for whom his estate
is preserved and augmented, and the only person who suffers under them is
the lunatic himself. There can be no question that the Court does its best
abcording to its lights and the powers at its command, but it is easy to con-
ceive a case in which it might heartily be wished that the Court could have
let the lunatic alone. The unfortunate Mr. Tovey seems to come near to

27^ No tea and News, [J uly,

realising that which has been sometimes treated as impossible — namely, the
case of a man who has been undone by haying a large estate left to him. One
of the clerical deponents whose affidavit was read to the Court stated that
during Mr. Tovey's residence at Goring he regularly attended the afternoon
services in the church of the adjoining parish of Stoke, as also the services
on the saiuts'-day evenings in all weathers, ''and for these and other reasons he
appeared to me to be a devout and religious man." There are, perhaps, people
who consider that a man who goes to church on saints* days gives prima
facie evidence of his insanity ; and such people may possibly feel thankful
that Mr. Tovey, being immured in an asylum, is prot-ected against indulging
a tendency which seems to have existed in his mind towards ritualism. It
was gravely propounded on one side as evidence of insanity, and denied on
the other, that Mr. Tovey put on board his boat a large image of the Virgin
Mary, and rowed it up and down the Thames. But if such evidence could
suffice to prove madness, sailors of the South of Europe are, and always have
been, mad.- Another deponent, who was chief constable and parish officer
of Goring, stated that he had been out boating wilh Mr. Tovey on the
Thames, and went with him to the Wallingford regatta. " He rowed me
there and back." If Mr. Tovey had been a dangerous lunatic, the worthy
chief constable and parish officer would have been in a position calculated
to excite lively anxiety in the minds of all inhabitants of Goring. The same
deponent says that during all the time he knew Mr. Tovey, which was nearly
three years, he always found him to be quiet and orderly. *' He never got into
any trouble or disturbance, and I never heard him use any violent or bad
language.'' Another important feature in the case was that the only act of
violence which was distinctly alleged against Mr. Tovey was one which
might very easily have been committed by a perfectly sane man.

it would show very small acquaintance with the character of mental disease
to argue from such evidence as has been quoted that the finding of Mr.
Tovey's insanity by the Commissioner ought to be set aside. But it is
possible that, if Mr. Tovey's rich uncle had not died, he would at this moment
have been occupied in aquatic amusements on the Thames on week days, and
in going three times to charch, at Goring or adjoining parishes, on Sundays.
The Lords Justices stated that 700/. a year is allowed for Mr. Toivey's main-
tenance, and that they are satisfied that nothing could be done for his comfort
and happiness more than is done at the asylum. It may be assumed as
probable that, if Mr. Tovey were allowed to live at Goring as little cared
ibr by the Court as in the days when he was comparatively poor, the sea-
nymph whom he met last autumn would become a river- nymph. The result
here indicated is doubtless shocking to propriety, and we are quite sure that
the wig of any Lord Chancellor, past or present, would stand on end at the
bare thought of it. But perhaps the system over which those learned digni-
taries preside is a little too elevated and spiritual for the capacity of average
human nature. A lunatic cannot marry, and society would call his cohabita-
tion with a woman by an ugly name. There are infinitely various forms and
degrees of lunacy, and we must once more guard ourselves against being sup-
posed to pronounce an opinion upon the case of Mr. Tovey. But that case
suggests that it is possible for the Court of Chancery to take a man who has
a large, fortune, and is in the prime of life, but is a little touched in the head,
and make a monk of him, and then report to itself that the comfort and hap-
piness of the lunatic have been effectually provided for at the expenditure of
700/. a year. — The Saturday Review, May 4.

1867.] Notes and News, 273

Emanuel Swedenhorg ,*

There has never been less likelihood than at the present time of Sweden-
borgianism taking any firm or general hold of the English mind. The whole
current of thought and belief in a matter-of-fact and unimaginative age is
dead against the progress of the New Jerusalem ark. Superhuman efforts
have indeed been made from the first to float the interminable volumes of the
seer's revelations. In his own. time they were printed at frightful cost, given
away to the public, and forced in bundles upon the bishops. It was for no
lack of zeal or liberality that the attempted revival of a few years ago came
to no more fruitful result. The patient scholarship of Mr. Garth Wilkinson,
the open purse of the Rev. Augustus Clissold, the shrewd sense Mid sterling
integrity of soul that might be looked for in a daughter of Joseph Hume,
were wasted upon a generation that was not worthy of them. A remnant
might still, indeed, be found faithful. Some of us may have known a solitary
confessor here or there brave the amazement or the contemptuous pity of a
club or drawing-room gathering. It is even said that, by a recent elevation,
these opinions have gained a representative upon the Equity bench. Yet the
litigation which rent the little sect half a dozen years ago came nearer than
anything else within our experience to a practical illustration of the infinite
divisibility of matter. A last chance for it seemed to offer itself in an alliance
with the spiritualist and table-rapping interest. Nor was it any unwilling-
ness on the part of the rappers and mediums that stood in the way. Sweden-
borg liimself was always a great card in the hands of the Homes, the Forsters,
and the Marshalls, and in that of M. Allan Kardek. But the exclusiveness
of the earlier theosophists barred the entrance into the Sweden borgian cave.
The ghosts that visited the great apostle and the spirits that rapped in
Hindmarsh's study knew nothing of the modern pretenders to spiritual sight.
The fate of all too narrow aristocracies seemed thus to have fallen upon the
short-lived revelation. The brief candle of Swedenborgianism had, to all
appearance, well-nigh spluttered itself out.

In Mr. White's recent elaborate work upon the life and writings of Sweden -
borg we see one more earnest and painstaking effort at vindicating the claims
of the philosopher and seer. It is the writer's design to raise the subject of
his biography from the vulgar level of a ghost-seer, or a mere enthusiast mis-
taking the nightmares or morbid visions of his own brain for exterior and
JEiwful truths. No human brain, Mr. White argues, could possibly have given
birth to such ideas. They must, therefore, have an independent basis of truih.
Credo quia impossibile est. '* It is idle to assert that he invented his 8[)iritual
world; such a power of creation does not belong to the human mind. He
most have seen what he describes." Yet Mr. White proceeds to make certain
distinctions between subjective and objective vision, which take off very much
from the value of his general adhesion to the substautialiiy of Swedenborg's
spirit world. Prom his remarks upon what the seer saw in the planets, he
appears to have little sense of the difference between the phenomenal and the
actual — no idea that physical truth is more than what a man troweth. " What
he relates may be true or untrue. I have no means of judging." PljysicHl
science is not therefore to come in as a test of the prophet's accuracy. Nor
does any amount of variance from fact of history detract from the seer's claims.

* • Emanuel Swedcnborg : his Life and Writings.* By William White. 2 vols,
London : Simpkin, Marshall, and Co., 1867.

274 Notei and News, [Jaljj

Wroug as he may be proved to be in matters where common-sense and human
testimony can bring him to book, this is no reason with Mr. White for distrust-
ing him where no such check npon his testimony exists. We are left in simple
wonder at the courage of a writer who can face the public with so absolute a
profession of faith in a witness of whom he suffers himself to speak, in one
passage, with abatements like the following :

** ' Do you, then, accept all Sweden borg has to relate concerning the Spiritual
World as true ?' By no means ; no more than I should accept the testimony
of the most veracious traveller as to the United States, or Russia, or India. 1
should say he means well, but had I to go over the same ground I should
certainly arrive at many different conclusions, and on some contradict him point-
blank. The full force of my dissidence from Swedenborg is not, however,
brought out by a comparison with travels in the United Stat^, Russia, or India.
In these lands are many stable phenomena, but observations taken in the Spiri-
tual World are as observations taken in cloud-land, where the shapes are transi-
tory ; and %or8e than transitory — ^illusory, by reason of their subordination to
the influence of the beholder. 'I can see no Spirit,' said Swedenborg, 'of
whom I cannot form an idea;' and supposing his idea incorrect (as many
chances against one it must have been), whom would he see P Out of the
enormous population of the Spiritual World, some one who answered to his idea.
Hence I have no confidence whatever that any Spirit he testifies he saw was the
real person. He disliked David and he disliked Paul, and he saw a David and
he saw a Paul to justify his dislike. The Moravians and the Quakers had dis-
gusted him, and he found pictures to match his disgust in the Spiritual World.
He fancied it would advance his Jerusalem in the favour of the great potentates
of Europe if they learned tbat their predecessors were in heaven, and forth-
with he reported Elizabeth of Russia, and Louis XIV of France, and George U
of England, as among the Blessed. I do not accuse him of any conscious hum-
bug in these stories ; I only adduce them to prove that he was liable to see
what he wished to see. Disregarding the authenticity of his portraits, we may
accept them as accurate reflections of the painter's own prejudices."

Where we at liberty to euphemerise upon the visions of Swedenborg, and to
see in them simply allegorical or poetic representations of his own crotchets in
the natural or spiritual world, there would be no harm in the admission that he
merely saw by tne interior light of sparks struck out of his own optic nerve*
But both the apostle and his adherents, including Mr. White himself in his
general argument, would repudiate such a tampering with the revelation.
Either Swedenborg's spiritual world was a real external world, or he sinks into
the common herd of monomaniacs who see an external cause in their morbid
impressions, and hear in their nightmares the accents of angels. If the planet
Mercury never contained a man who ^' wore a garment of deep blue, fitt^
tightly to his body, without folds or frills," or if there are not people in Mars
wiio live on fruit and pulse, with garments made from the fibrous bark of trees,
woven and stiffened with gum, or if there are no wild horses in Jupiter, tlien
we must simply decline to see by Swedeuborg's eyes when he takes us into
realms even more Inaccessible to our own homely organs of sight.

Swedenborg lies altogether apart from the ordinary run of religious mystics.
He has little in common with Jacob Boehmen, or Saint Martin, or Pascal or
Madame Guyon. Of Boehmen, indeed, he professed entire ignorance. Nor had
other writers much more share in shaping his peculiar tenets. In no respect
is the force of Swedeuborg's inventive talent more characteristically shown than
in his utter disregard of what had been said or done by other men. The most
voluminous of writers, he is the most dead or indifferent to literature. We
know from his own account that he had hardly a book beside the Bible. This
habit of intellectual self-dependence was part of the legacy- of character be-
queathed him by his father, Jesper Svedberg. Mr. White's pages contain some

1867.] Notes and NewB. 275

amusing traits of Bishop Svedberg's self-sufficiency and meddlesome habits.
In his shrewd sense, his stirring methods of business, and his practical wajof
jietting on in the world, there is much that reminds us of Bishop Burnet. His
begging letters are models. The King can refuse him nothing. At his im-
portumty the patent of nobility was granted to his sons and sons-in-law by
^een Ulrika Eleonora in the year 1719. Emanuel's surname was thus changed
from Svedberg to Swedenborg. Of the Bishop's family of nine all but one
were, like himself and his wife, '* Sunday children," in which circumstance he
sees an augury of the godliness of his house. To judge from Swedenborg's
recollections in his old age, his childhood was one of precocious piety. Prom
his fourth to his tenth year his thoughts were constantly engrossea '^ in reflect-
ing on God, on salvation, and on the spiritual fifPections of man." The things
he revealed in Ids discourse so astonished bis parents that they declared angels
certainly spoke through his mouth. On matters of dogmatic faith — such as
the Trinity, justification by faith, and imputed righteousness — he was strangely
heterodox for a clergyman's son. It does not appear that Swedenborg carried
his early pietism into his youth or early manhood. When he was at the uni-
versity, and for many years afterwards, liis ruling passion was for science. It
was for this that he travelled repeatedly to Germany, Italy, Holland, and Eng-
knd, and sought the converse of Wolf, Plamstead, Halley, and Newton. His
first works of importance were upon chemistry and geology, upon iron and the
nature of fire, and upon the mechanical principles of building docks and ship-
ping. The discovery of the longitude at sea was a favorite idea with him
through life. The three folios of his great work, the ' Opera Philosophica et
Mineralia,' were published in 1734.

The most valuable portion of Mr. White's book is his analysis of these
volumes. In his grasp of philosophical principles and his insight into the
leading truths of physics, Swedenborg was clearly in advance of most men of
his time. And in certain special departments, especially that of metallurgy,
his practical knowledge has scarcely been surpassed in our own day. The chapters
on the conversion of iron into steel were incorporated into the magnificent
'Description des Arts et Metiers,' as having been spoken of both by Cramer and
Br. Percy as forming a landmark in the history of metallurgy. Mr. White is
careful at the same time to discountenance the flights in which Mr. Emerson
and other writers have indulged regarding the anticipation by Swedenborg of
most of the leading discoveries of recent science. It was in his views of mag-
netism that he came nearest to the conceptions of our day. It was already clear
to him that heat, light, and electricity, were but modifications of one element—
the magnetic — which filled all space, and was the impelling principle resident
in ail cosmical bodies. The universe was a great magnet. In his * Economy
of the Animal Kingdom,' published in 1714, Swedenborg prosecuted his re-
searches into the nature of life and the soul, which led him into a general har-
mony with the doctrines of Wolf. No one has given so clear an account as
Mr. White of the peculiar teaching of Swedenborg concerning the first sub-
stance, the auras, and the animal spirits or nerve force, with the latter of which
he identified the soul. Swedenborg's language here comes close upon the
spiritualist or animal-magnetist terminology of our day. His design, in common
with our modern mediums, was to demonstrate to the senses the immortality of
the soul. And it is easy to detect in his speculations upon this theme the germ
of the fanciful doctrines concerning the world of spirits which have since made
his name famous.

It was in his fifty -fifth year, a.d. 1743, that the spiritual world distinctly
opened itself to Swedenborg. A new life then dawned upon him. It was in
London that this change took place. A curious light has been lately thrown
upon this crisis of his career. A ' Diary or Book of Dreams,' written by
Swe(ij[entM)rg in 1743-4, turned up in MS. at Stockholm in the year 1858. Its

276 Notes and Newi. [J uly,

genuineness was beyond doubt. A limited number of copies — some of its con-
tents being of an obscene character, or only fit for tlie pages of a medical
journal — were printed in the following year. We here get Swedenborg's own
version of the memorable incident handed down by Wesley, on the authority of
Brockmer, with whom Swedeaborg lodged in Fetter Lane. After all that
Mr. White has done to disparage the credit of Wesley, there can be no doubt
that Swedenborg had at that time an attack of madness following upon acute
dyspepsia. The *' violent shudderings ** and fits which he had ten or fifteen
times, together with the visions which appeared to him of angels, serpents, big
dogs, palaces, and women, were clearly nothing else than his own sense of what
were to other eyes simple symptoms of ordinary mania. The well-known story
which he told Robsahm of the hideous reptiles that crawled about the floor, and
of the angel who said to him '* Do not eat so much," is merely another reflec-
tion of what passed through tiie morbid brain in the crisis of fever or dyspepsia.
It appears to Mr. White " only pert scientific ignorance " to put down Sweden*
borg's later rhapsodies through the space of seven-aud-twenty years to the
score of hi^ being out of his mind in 1774. In his view it is out the *' sick-
ness of the ( agle moulting." Not questioning but that the ' Book of Dreams/
or even the published spiritual ' Diary,' would have sufficed to shut up the
writer nowadays in an asylum, Mr. White boldly pins his faith on the objective
reality of the sights in the ' Arcana Celestia,' and has no doubt that the eagle
winged an actual flight to heaven and hell. He is quite prepared to see liis
oracle ** sharply tried," and his claims tested, not by debate "outside his
writings," but by critical study of the statements themselves. Nothing, we
admit, can be fairer. And we can promise those who have leisure and curiosity
enough to take up the challenge and follow Mr. White through his elaborate
and loving exposition of his master's occult lore, that they will meet with much
that will enliven the tediousness of the journey. How far, however, they will be
converted into seeing with Mr. White's eyes the glory of the seer's countenance,
and fall down with him before the oracle, it is not for us to say.

But if, by reason of his " style, originality, and indiscreet disclosure," the
" superficial public'' are repellea from Swedenborg, the great teachers of man-
kind, Mr. White is convinced, will rise more and more into accord with the
seer's philosophical and ethical system. In the union of utilitarianism with
transcendentalism which begins to characterise our b^st literature, we are told
that " we breathe a Sweden ooi^ian air." In one of Coleridge's daring para-
doxes, that '* as a moralist Swedenborg is above all praise," Mr. White would
have us see a literal truth. If this means that Swedenborg correctly reported
the morality of the spiritual world, we are, of course, thrown back once more
upon the credibility of his pretensions. It would doubtless be shocking and
profane to question the purity of the ethical code of the heavenly world. But
if we are to accept, witli Mr. White, the goir)gs-on before the seer's eyes as
indubitable facts, we may realise to ourselves the feelings of a pious and
orthodox Greek or Roman of old in face of the sad scandals of his !rantheon.
Less scrupulous or more sceptical followers might find their advantage in fol-
lowing the extremely loose and comfortable precedents set by such august
authority. In his treatise on * Conjugal Love,* for instance, we are enlightened
as to the relations between the sexes in the glorified or celestial Jerusalem. In
some respects we may suspect our Mormon brethren to have taken a leaf here
out of the Swedish revelation. In others we must acquit Joe Smith or Brigham
Young of tenets or practices half so foul or cynicnl. In the Swedenborgianrule
as to women we recognise the moral estimate of the Koran mixed up with the prac-
tical license of the Hay market. Adultery, indeed, is condemned altogether — it is
a synonym for hell. But to a "youth of strong passions, and unable to marry,"
the spirits would say, with Cato, maete viriute, ** Promiscuous and inordinate
fornication," thougti ''venial, and capable of containing conjugal love as a

1 867 .] Notes and News, 277

sword lies in a scabbard," is best set aside in favour of a mistress, " who
must neither be a maiden nor a wife.*' The case of married men is provided
for on the same lenient scale. " There are twa kinds of concubinage, which
differ exceedingly, as dirty linen from clean — the one conjointly with a wife, the
other apart from a wife." To the first heaven is closed, and the sinner is sent
by the angels among the polygamists. '* But it is not at all the case with him
who for good reasons divides himself from his wife and keeps a woman." These
reasons are of three degrees — "legitimate, just, and truly excusatory." A
legitimate license is the adultery of the wife. A just license is found in a scale
of *' vitiated states" of the body or mind. Among the former of these are
*' foul eructations from the stomach," and among the latter *' foolishness and
idiotcy, loss of memory, and the like." Por really excusatory causes one need
go no further than '^ gossiping about family secrets, quarrelsomeness, internal
dissimilitude — whence comes antipathy, extreme impiety, or addiction to magic
and witchcraft." But tbere is a kind of supplemental code in " a cessation of
prolification on account of the wife's age," besides similar '* causes which reason
sees to be just, and which do not hurt the conscience." The New Jerusalem
may well be an attractive place for a male devotee of a certain order. But
what is woman's place in this celestial Agape mone ? We fear that Swedenborg's
spirit saw in women no souls, and the * Arcana Celestia' certainly holds out no
paradise for female adherents.

With these visions to back him, there need be no wonder when we find the
great apostle exemplifjiug the celestial code in his own practice upon earth.
J^'or "coniugal love" he seems to have felt no vocation, but his repeated con-
fessions show that he found an alternative in the saving clauses of the new code.
In his youth, while in Italy, and we are not told how long afterwards, he
acknowledged keeping a mistress. His private confessions, as evinced by the
entries which we are permitted to see in his diary, sufficiently show that his
celestial converse had done little to eradicate or keep in check the ordinary
lusts of the flesh. Such minor weaknesses are admitted by his biographer,
much as a sun-worshipper might pass by the existence of spots on the face of
bis idol. The gentle protest of Mr. White against the " heartlessness" and
laxity of Swedeuborg is even tempered by a tacit admiration of the seer's
"outspokenness" as compared with the reticence of a later and more prudish
generation.

Are we to take, as a further test of the high morality claimed for Swedeu-
borg, his monstrous and unscrupulous attack upon the Quakers ? What are
we to think either of the love of truth, the sense of responsibility or the simple
decency of a nian (whom we are forbidden to hold insane) who can deliberately
charge upon that community the foul and unnatural practices which were
attributed to the Christians of the first centuries by their heathen persecutors,
and which were subsequently, with perhaps an equal amount of truth, laid by
the orthodox to the score of the Gnostic heretics ? ** It was inquired whether
the Quakers indulged in these obscene rites with their daughters and maid-
servants, and it was said that they did." It was said to him " by an angelic
interpreter that Quaker spirits wander about in thick forests like swine, and
this because of their avarice and nastiness." We shall of course be told that
Swedenborg merely reported what met his ear in the land of spirits, and that
he b in consequence not to be held responsible for the libel, it is upon the
spirits then, we conclude, that the responsibility is to rest. This will of course
be satisfactory enough to those with whom the spirit world is an objective
reality, and the report of the seer an authentic message. But what resource
is there for the outside public, who have the disadvantage of not being mediums,
and with whom the objectivity of the spirit voices is the very point to be made
good F Are they to follow the precedent of the dispassionate judge of former
times and order the ghost into court ? If they are estopped from trying the

278 Notet and Neu>$.

memenger, wbat, tt least, are thej to do but make trial of the spirits themselves
by such partial lights as they possess in respect to matters of mott and the laws
both of the physical and the moral universe P Taking the utterances of their
messenger with the implicit confidence which discipks like Mr. White would
have us repose in him, we are thus thrown upon what we are told is a higher
moral and spiritual sphere than our own for evidence of what we know to be a
revolting and scandalous falsehood touching the sphere of our own senses.
What appeared in the eyes of Swedenborg himself, and, it may be, still appears
in those of his biographer and similar privileged adherents, to be an angel of
light, must, to eyes not accustomed to the same ethereal medium, stand out in
the unmistakable character of the father of lies. It is somewhat odd to find
ourselves in the position of arguing, even with a semblance of gravitv, upon
such preposterous notions as these. But the oddity is due to the stiU more
curious paradox of men with the intelb'genoe and culture of Mr. White being
found to stand sponsors for such claims. If the outpourings of Swedenborg
are to be taken as evidences of fact, we may reasonably hope to utilize the
ravings of our asvlums. If we want to know what the sun is made of, whether
the moon is inhabited, or what is going on in the recesses of heaven or hell, we
have but to keep up a class of Pvthias of either sex, well grounded in physics
or theosophy, with a good deal of what Mr. Emerson calls the " oversoul/' an
inordinate stock of self-confidence, and a high state of indigestion. There need
be neither a problem in cosmical science nor a mystery in theology waiting its
solution, had we only a supply of men qualified for service in Ohurdi or State
by the natural gifts of a quick and teeming brain — developed enormously in
^e regions of wonder, imagination, and sel^e8teem — untiring animal energy,
and a disordered liver. — Tke Saturday Review, May 11th.

Dr, Forbes Wifulow on Light.*

Books could be named which prove that the results of strictly scientific
inquiry possess an interest little inferior to the romance of life, by showing how
the elements of energy and unity, of antagonism and harmony, may be observed
in the material forms and forces without us in a mysterious intricacy almost as
interesting as that play of human motive and action traced by the hand of the
poet, novelist, or historian. Yet it is unnecessary that every work on a scien-
tific subject should be strictly scientific in aim or even in method and detail ; it
is nevertheless necessary that every work of avowedly popular purpose should
evince in its author that tone and habit of thought which will guide him to a
consistent, if not a complete, view of the character and relations of his subject.
Now, Dr. Winslow*s book on Light is interesting as an example of what a work
on the subject ought not to be. The first chapter, on the Solar Beam, is
mainly derived from works on physical geograpbv and botany ; and it treats on
the general influence of the sun on the distribution of plants and animals.
Such discussions, or rather statistics, are very well in their proper place, but
here they are beside the question. Physicists have shown, for instance, that
light and heat are only different forms of one and the same physical agency,
though they specially affect different senses and organic modes ; and when we
regard the sun as the centre of gravitating and magnetic influence, and of the
heat, light, and chemical power which we are accustomed to distinguish in its
emitted influence, it may fairly be asked why " Light" should be selected as the

* 'Light: its Influence ou Life and Health.' By Forbes Winslow, M.D.
London : Longmans and Co., 1867.

1867.] Noiet and News. 279

title of a book relatine to phenomena witb which everj science is concerned, and
nrhich lyre more cloae^ related to other forms of solar energy.

The book is indeed a misnomer ; and this must either be regarded as involving
the dificrimination of the writer, or it must imply that the title sets forth a
theory that light is to be regarded as the physical cause to which we should
attribute the various results which the author has narrated. If the former
altemative had been clearly and exclusively applicable, we have already said
more than enough, for in \hsX case we should have said nothing at all ; but the
latter is rather curiously justified in the only two references to optical science
or physical theory that occur in the volume. At the end of the first chapter
Pr. Winslow refers to the important investigations of Bunsen and Kirchhoff on
the nature of certain dark lines in the solar spectrum, and says he will recur to
the discovery " for the purpose of ascertaining to what extent the development
of the red blood cell ana the iron found in the general circulation depend upon
the mechanical or chemical efiPect of the solar beam — containing m its com-
position this metal — upon tlie portions of the body exposed to its operation.*'
Kirchhoff proved the presence of iron, among other metieds, in the solar *' atmo-
sphere,^' and by inference it may be supposed present in the incandescent surface
or stratum beneath it; and accordingly we felt somewhat curious to know
what was meant by the extension of the discovery implied by the mechanical
effect of the iron contained in the solar beam. At the end of the work we came
upon the following sentence : — " In the absence of any hypotheses of a more
satisfactory character to account for the beneficial action of light, it is reason-
able to suppose that the iron vapour detected in the sun*s beam may have a
physiological as well as a mechanical effect upon the composition of tiie blood
Dj throwing into the general circulation through the vessels of the skin a most
important vital constituent/' Though in his preface our author disavows any
daim to original experimental research, and does not purpose to weigh the
relative values of the theories of light, he thus exhumes the corpuscular theory
and revives it with a vengeance. That we have particles of iron drilled into
our very blood in actual " showers" of sunshine is a bold theory, and dead
against the art and|mystery of wearing clothes. Surelv the advantages of taking
steel-drops per cutem never struck anybody in this light before ; and though
we are not told what are the therapeutic advantages of having particles of
sodium, nickel, calcium, magnesium, barium, copper, and zinc pelted into us,
8ome may fairly regret that no traces of gold are found in the solar atmosphere
to act as an encouragement in laying oneself out for an easy method of accumu-
lating that valuable metal. Any one wishing to defend this hypothesis will
have to explain why solar ''atmosphere" and solar '* beam" are to be considered
identical ; how it is that while the dark lines of the sun^s prismatic spectrum
evidence the interference or absorption of certain forms of light, the spectra of
the incandescent metals afford bright lines instead ; and when done the
insuperable objections to the theory are onlv beginning.

The chapters on lunar influences record effects attributed to the moon as
matters of hearsay, which the reader may believe or not as he pleases. The
author does not hold himself bound to investigate such questions, or even to
trace any clear connection with the subject on hand. The moon must have been
man's primitive guide in fixing periodic times and observances ; and, apart froixi
light, her relations to the earth, in a system of two bodies moving round their
centre of gravity, undoubtedly affect other physical phenomena beside tlie tides.
It is therefore not difficult to understand how almost all our more obvious and
minor periods observed in natural phenomena have been attributed to lunar
influence, though many are very remotely connected therewith ; nor in the
present state of science need we affect to be surprised should the moon be found
to have importiuit relations which are either denied or undiscovered. Besides,
a rational view of tha nature of causation shows us that sinoe all cosmicai

280 Notes and Neivs. [July^

})erio€ls are interrelated, and since all physiological and physical effects which
they conjointly determine cannot be specially attributed to one independent
cause apart from others, it follows that much vagueness must always beset our
popular method of tracing special causes and effects. Not only Dr. Winslow's
book, but almost ail our deauct ions from whole series of observations in kindred
departments, are whollv vitiated from the universal disregard or ignorance of
the principle that periodic change^^ whether of the moon as a great neighbouring
centre of influence, or of some small object, cannot be classified distinctly as
"causes" or "effects," but merely as tigns of the variation in special forms of
an all-pervading and ceaseless activity.

Uufortuiiately, iu the very department of inquiry in which Dr. Winslow ranks
as a high authority, he merely tells us, after giving the conflicting opinions or
others, that *' phcing but little faith in what has been said on the subject L
have not kept any systematic register as to the effect of different phases of the
moon on the insane." AVhen, as we have hinted, sigm rather than causes wil/
be sought after in the study of physiological and other influences, systematic
registration of phenomena will become the basis of a scientific method which will
be proud to acknowledge that in these matters we must walk by sight and not
by faith, nor by the want of it in any predevised theory.

Dr. Winslow's last and shortest chapter on the Hygiene of Light makes some
approach to the subject on wliich the work ought to have treated ; and it is not
the less worth reading, perhaps, that extracts are drawn from the writings of
Sir D. Brewster, from Miss Nightingale's admirable book on hospitals, and from
the pages of this journal. If Dr. Winslow had kept to his subject his extra-
ordinary diligence in collect inj; materials would have secured the value and
importance of his book in relation to a subject on which people cannot read too
much. It is necessary in every form to set forth known truth on the sanitary
value of light and air, though that truth be backed up bv no specious hypothesis,
and be apparently addressed to some faint sense of justice in man rather than to
an ignorant but keeuly active selfishness too seldom disturbed by the power of
the law, and which therefore cannot be too often assailed by the force of reason.
It may be difficult to say whether ignorance or cupidity is more concerned in
the o])position to sanitary reform ; yet we shall be disposed to forgive much in
an author who does something in any direction to advance the state of public
opinion on such worldly interests as are concerned in the condition of our
street.s and lanes, the structure of schools, hospitals, and servants' apartments ;
and, in the aid of all who cannot, or do not, help themselves, to cherish in men
that " unerring instinct" which attracts us to the wholesome light of heaven. —
Pall Mall Gazette, June 20.

Modern [Bomish) Idea^ of HelL^

Mr. Furniss's book is one of a series expressly intended " for children and
young people ;" an extract from Father Faber, on the fly-leaf, gives us to under-
stand that we are much too qualmish about mentioning " the scaring images of
Hell, and that children are lost for want of being early smitten by terror !" Our
readers will remember that M. Octave Delepierre recently edited for the Philo-
biblion Society a series of "Visions of Hell," all belonging to a mediaeval
period.f The editor, and the public generally who studied that stirring collection

• * The Sight of Hell.' By the Rev. J. Fumiss, C.S.S.R. PermUsu Supe-
riorum. (Dufl^.)
t See ' Journal of Mental Science,* October, 1866. Notes and News.

1 867.] Notes and Nfws. 281

of mvtks, fancied, no doubfc, that they all belonged to a mediaeval period. The
authorship of the stories did, but tliere are existing writers who continue to
labour in the same vocation, and Mr. Eurniss, " by permission of his superiors,"
is as ardent as any of them in this agreeable line.

His book is but a pamphlet, but it is stuffed with as many horrors as if au

£ncyclop£edia had been devoted to the subject ; and it is after this fashion that

children belonging to the Church of which Mr. Furniss is a zealous teacher,

^re encouraged to have their trust in a God who is, before all things, a God of

Xjove. Children are informed that Hell is four thousand miles from the surface

C3f the earth, that the fair saint, St. Francis, has been taken over the interior of

%\aX place of torment by the angel Gabriel ; and from her account and that of

other witnesses, living children have an opportunity of knowing whither they are

sure to go, and what they are certain to suffer, fur ever and ever, for the smallest

mortal crime committed in the flesh. Let us here remark, parenthetically,

that we have no opinion to offer touching the theological character of the book.

17e take it as a literary and social illustration of what is now beino^ written,

and of the influences it is expected to have on a rising generation. We commit

all besides to the fair judgment of our readers.

Mr. Furniss then informs the young that Hell is boundless, its plain is of
red-hot iron, its atmosphere a fog of fire, its rivers fathomless streams of
seething pitch and sulphur. Take the least spark from Hell (he says), throw
it into the ocean, and in a moment it will dry up all the waters and set the
whole world in a blaze. Tiie music of Hell is not that of the spheres, but
made up of shrieks tliat never subside, and unnatural sounds from the con-
demned, who roar like lions, hiss like serpents, howl like dogs, and wail like
dragons. There is a rushing thunder as of cataracts of water, but little chil-
dren are reminded that there is no water in Satan's fiery kingdom. What
sounds like the fall thereof are the torrents of scalding tears falling without
any cessation from millions of millions of eyes! The young, too, are further
sickened by the assurance that if a body could be snatched for a moment from
Hell and laid upon the earth, the stench would be so overwhelming that every-
thing would wither and die. Then the little ones are further scared by the in-
formation that millions of fiends are daily despatched from the Bottomless Pit
especially to tempt children to sin, and that the fiends are well beaten when
they return home at night if they have been unsuccessful in destroying the souls
of children throughout the day. As for the awful subject of judgment, these
little ones again are told that their offending souls will be dragged in chains
before Satan's judgment-seat, that he is their judge, — and a judge without
mercy !

If the pulses of the young heart of innocent girl or boy reading, or listening
to these lessons furnished to them with a diabolical sort of alacrity by the
author, still beat unappalled, Mr. Furniss crushes them with fresh horrors,
" How will your body be," he asks, " after the Devil has been striking at it a
hundred million of years without stopping V* Every naughty child has a spe-
cial devil at its side to smite it (amid countless other outrages) for ever and
ever; and Mr. Furniss asks his dear young friends." if they go to Hell," what
their ijodies will be like after their attendant fiends have been pounding at
them a poor instalment of the time, a hundred million years ? Fancy a group
of childreif, fresh as flowers, confiding as innocence, with young life and a
divine love within them, being asked such a question as this ! The mortal fault
of a moment deserves endless torture beyond the heart of man to conceive ;
about that, Mr. Furniss tells the scared innocents, thete can be no doubt. He
seems to lift his voice shoutingly, as if his tender and terrified flock should not
hear the more loving words from the Fountain of love and mercy, — " Suffer
little children to come unto me" No ! teaches the author, they cannot, and
they shall not, if they bear about them the responsibility of the least of mortal sins.

a82 Notes and Neua. V^^^lt

The imagination grows more horrified with that which i» supplied for its food
and stimulant. The little ones are told that devils will be continually frighten-
ing tliem. Death staring at them ; the vain will have to wear bonnets and
dresses of the hottest fire of Hell, which bums everything for ever, and never
burns anything awav. A poor girl who loved dancmg in the world implores
Satan to let her little brothers and sisters know what has come of it ; but, of
course, Satan will not help her. The children of of earth are even bidden ta
look into the horrible gulf to behold their fathers tossing in it helplessly;:
others are shown whole families, the members of which are tearing each other
to pieces ; which are renewed, to be again torn, each accusing the other of the
calamity which has overwhelmed all. In short, within a few pi^es aro
enumerated horrors which defy all description. Almost universal empire is as-
cribed to Satan ; all power over men is ascribed to him ; the might, majestya
the love, the very will of God are burnt out by the all-devouring flames o1
Eternal Hall ; and Christ is depicted as rather Querulously stating that he hac
done his utmost to save mankind, but that the Devil, after all, had by far the
best of it !

We add no word to this illustration. Judgment is free. We will only say-
that in all the myths of the Middle Ages, there is not one so utterly astounding,
so horrible, so repulsive, and so mendacious as the myths of the present time
depicted by Mr. f umiss, permissu superiorum* — The Aihenaum,

Pavilion Asylums.

In a paper which he read before the Medico- Psychological Association, and
has now reprinted from the ' Journal of Mental Science,^ Dr. Lockhari
Robertson advocates the application of the pavilion system of construction, stf
exemplified in the Herbert Hospital at Woolwich, to the building of public
asylums for the insane. We can readily conceive that there might be some
great advantages in breaking up a large asylum into separate pavilions, con-
nected by suitable corridors, and under one administration. The best ven^
tilation would, at any rate, be obtained ; and it might be desirable, for other
reasons, to do away with the congregation under one roof of so many
kinattcs. Facilities would be presented for a complete classification of the
patients according to the nature of their disease, their bodily condition, and
the probabilty of recovery. The system contains within itself the means of
an easy and inexpensive extension, in case of an increase of accommodation
being found necessary ; and there seems no reason to think that the efiicacy
of the administration would be at all interfered with. Dr. Robertson
appends to his paper the plan of a pavilion asylum for 250 patients, with
easy means of enlargement for 400 or 550 ; and claims for it the merit of
economy. Though there may be reasonable doubt of this in some minds,
the pavilion system of construction certainly seems to ofiTer undoubted ad-
vantages over the modification of the prison system which is in foshion, and
may fairly claim a trial, should it be found necessary, to add another to
the numerous large asylums scattered over the country. — Britisk^ Medicai
JourrmL

1867.] Notea and News. 283

The Emprets Charlotte,

We regret to learn that the mental condition of the Archduchess Charlotte,
Empress of Mexico, shows no signs of improvement. Under the stress of the
peculiarly distressing symptoms with which meutal alienation is accompanied im
her case, the committee who have been charged bj the Emperor of Austria
with the administration of her affairs and her personal charge, have proposed to
have a consultation of eminent European alienists, naming for the purpose —
Dr. Griesinger, Berlin ; Dr. Morel, Paris ; and Dr. Maudsley, London. — British
MedtcalJ&umal, May 18.

Publications, 8fc,, Received, 1867.
(Contimed from the * Journal of Mental Science ' April, 1867.)

* On the Principles of Esthetic Medicine ; or, the Natural Use of Sensation
and Desire in the Maintenance of Health and the Treatment of Disease, as
demonstrated by Induction from the Common Facts of Life/ By Joseph Peel
Oatlow, M.R.C.S. John Churchill and Sons, New Burlington Street, 1867.
pp. 325.

The dedication of this work was written in 1853. The author's sudden death
ie/t the MSS. unfinished. It is now, in 1867, launched on the world apparently
'tnthout any further editing or amending^ a step which can conduce neither to the
lame of the author nor to the profit of the publishers.

'Idiocy and its Treatment by the Physiological Method.' By Edward
Sequin, M.D. New York, 1866, pp. 457. (See Fart II, Reviews.)

* Ninth Annual Heport of the General Board of Commissioners in Lunacy
for Scotland.' Presented to both Houses of Parliament by command of Her
IMajesty. Edinburgh, 1867, pp. 274.

A model of accuracy.

' On the Poisons of the Spreading Diseases : their Nature and Mode of Dis-
tribution.' By Benj. W. Richardson, M.D., P.R.S., Senior Physician to the
Royal Infirmary for Diseases of the Chest. John Churchill and Sous, New
Burlington Street, 1867 (pamphlet).

A thoughtful and suggestive Lecture,

' Hospitals, Infirmaries, and Dispensaries : their Construction, Interior
Arrangement, and Management; with Descriptions of Existing Institutions,
and Remarks on the Present System of affording Relief to the Sick Poor.* By
F. Oppert, M.D., L.R.C.P.L., Physician to the City Dispensary. John
Churchill and Sons, New Burlington Street, 1867, pp. 218.

An able and practical treatise, to which we shall revert more fully in a future
number.

* Grerminal Matter and the Contact Theoiy.' By James Morris, M.D. Loud,
John Churchill and Sons, New Burlington Street, 1867 (pamphlet).

284 Notes and Newi, [July>

* On Happiness in its Relations to Work and Knowledge.* An Introductory
Lecture delivered before the Members of the Chichester Literary Society and
Mechanics' Institute, October 25th, 1850, and published at their request. By
the late Sir John Forbes, M.D., F.R.S., Physician to Her Majesty's Household.
Second Edition. London : Hamilton, Adams and Co., 1867 (pamphlet).

*The Natural History Review for October 1862.* Containing "A Report
on Recent Researches into the Minute Anatomy of the Spinal Cord." By
W. B. Kesteven, E.R.C.S.

" Report on Dr. Dean's Smithsonian Contribution on " The Gray Substance
of the Medulla Oblongata and Trapezium." By W. B. Kt^steven, F.R.C.S.
(Reprinted from * Beale's Archives of Medicine,* No. 16, 1866.)

* Classification of the Functions of the Human Body, and the Principles on
which it Rests.* By Andrew Buchanan, M.D., Professor of Physiology in the
University of Glasgow. London: John Churchill and Sons, New Burlington
Street, 1867 (pamphlet).

* Lp9ons Cliniques sur les Maladies des Vieillards et les Maladies Chroniques.'
Par M. Le Dr. Charcot, Agregc a la Faculte de M^decine de Paris, Medeciu
de rilospice de la Salpetriere; recueillies et publiees par M. le Dr. Ball,
Agre^^ a la Facull6 de Mddecine de Paris. Deuxieme Fascicule. Goutte et
Rhumatisme Chronique. Paris: Adrien Delahaye, Libraire-Editeur, Place
de L'Ecole-de-Medeciue, 1867.

'Farewell Address, delivered at the Fourth Anniversary of the Aiithropolo-
logical Society of London, January 1st, 1867.' By James Hunt, Ph. D., F.R.S.,
&c. &c., President of the Anthropological Society of Loudon. London:
Triibner and Co., 60, Paternoster Row, 1867 (pamphlet).

*Ueber Lear uud Ophelia.' Ein Vurtrag von Professor Dr. Heinrich
Neumann, Gehalten im Musiksaale der Universitat zu Breslau am 11 Marz,
1866. Breslau : Verlag von Wilh. Gotil. Korn, 1866 (pamphlet).

An interesting contribution to the Psychology of Shakespeare,

Appointments.

Dr. Harrington Tuke and Dr. Maudsley have been elected honorary members
of the Imperial College of Physicians of Vienna.

Dr. Fryer, F.L.S., &c., late Senior Resident Medical OflBcer at St. Mary's
Hospital, Manchester, has been appointed Physicians' Assistant to the West
Riding of York Lunatic Asylum.

W. F. Crosskey, M.D., has been appointed Assistant Medical Officer to the
Birmingham Borough Lunatic Asylum, vice J. IJ. Davidson, M.D., resigned,
and appointed Assistant Medical Officer to the Cheshire Lunatic Asylum,
Cheshire.

William Stanger, Esq., has been appointed Assistant Medical Officer of the
County and Borough Lunatic Asylum, Sueinton, Nottingham.

James Buchanan, A.M., M.B., and CM. Glasg., has been appointed Assistant
Medical Officer to the Perth District Asylum, Murthly.

1867.] Notes and Newa. '285

Extraordinary Meetings of the Medico-Psychological Society

of Paris.

The Medico-Psychological Society of Paris has organised extraordinary
meetings for the week preceding the time fixed for the General and Universal
Medic3 Congress of Paris of this year, viz. on August 10th, 11th, and 14th.
The meetings will take place at the Faculty of Medicine, at four in the after-
noon. Full liberty is left as to the choice of the subjects for papers ; but the
Society would direct attention to the following topics : —

1. Appropriate legislation and mode of relief for the insane in different coun'

tries.

2. Relations of insanity to private and public education,

3. JBasis of a general system of asylum statistics,

4. On the pathological changes of the nervous centres in the various forms of

insanity, and especially on the progress effected in this respect by the use
of the microscope.

The members of the Medico-Psychological Association are invited to attend.
We are requested to add to this statement the earnest wish of the SocietS
MSdico-Psychologique that the English Association may be farly represented at
this congress.

Notice to Corresj!)ondents,

English books for review, pamphlets,exchange journals, &c., to be sent either
by book-post to Dr. Hobertson, Hayw^ard's Heath, Sussex ; or to the care of
toe publishers of the Journal, Messrs. Churchill and Sons, New Burlington
Street. French, German, and American publications may be forwarded to
Dr. Bx)bertson, by foreign book-post, or to Messrs. Williams and Norgate,
Henrietta Street, Covent Garden, to the care of their German, French, and
American agents, Mr. Hartmann, Leipzig; M. Borrari, 9, Hue de St. P^res,
Paris ; Messrs. Westermann and Co., Broadway, New York.

Authors of Original Papers vnshing Reprints for private circulation can have
them on application to the Printer of the Journal, Mr. Adlard, Bartholomew
Close, E.U., at a fixed charge of 30«. per sheet per 100 copies, including a
coloured wrapper and title-page.

The copies of The Journal of Mental Science are regularly sent by Book-post
{prepaid to the ordinary Members of the Association, and to our Home and
Foreign Correspondents ; and Dr. Robertson will be glad to be informed of any
irregularity in their receipt or overcharge in the Postage.

The following EXCHANGE JOURNALS have been regularly received since
our last publication :

The Annates Medico-Psychologiques ; the Zeitschrift fur Psychiatric; the
Correspondenz Blatt der deutschen Qesellschaft fur Psychiatric ; Archiv fur Psy-
ehiatrie; the Irren Freund; Journal de MSdecine Mentale ; Archivio Italiano
per le MakUtie Nervose e per le Alienazioni Mentali; Medizinische Jahrbucher

VOL. xm. 20

286 Not€9 and New^. [July,

{Zeiisehrijt der K, K. GetelUehaft der Aerzie in JFien) ; the Edinburgh Medical
Journal; the American Journal of Insanity ; the British and Foreign Medico-
Chirurgical Review; the Dublin Quarterly Journal; the Medical Mirror;
the British Medical Journal ; the Medical Circular; the Journal of the Society
of Arts; and New York Medical Journal, Also the Momingside Mirror; the
lork Star; Excelsior^ or the Murray Royal Institution Literary Gazette,

ERRATA.

In an article entitled " Contributions to the Pathology of Nenrous Diseases/' in
the April number of the Journal, the following errors make nonsense of an im-
portant passage. We quote the passage, marking the errors by italics. " It is
clear that the left hemisphere was cut off both from knowledge of, and power of
acting upon the limbs of the opposite (shotdd be same) side ; fbr, although it was
in full function, the patient was unaware of her hemiplegia — the left (should be
right) being so disintegrated as to be unconscious of it. And the exauiple would
seem to show that one hemisphere can only act volitionally on the limbs of the

same (should be opposite) side And of course if the hemiplegia was not

real, there was no reason why the right (should be left) hemisphere should not
have been able to act upon the limbs, except that it was cut off from communi-
cation.*'

L 867.] 287

THE

ANNUAL GENERAL MEETING

WILL BB HBLD
(BY PERMISSION OF THE PRESIDENT AND FELLOWS)

AT THE

ROYAL COLLEGE OF PHYSICIANS OF LONDON,

On WEDNESDAY, JULY 31st, 1867.
Under the PRESIDENCY of LOCKHART ROBERTSON, M.D. Cantab.

AGENDA:-
L MSETING OF THE GENERAL GOKMITTEE, at 11 a.m.
n. HOBNINa MEETDra OF THE ASSOCIATIONj at 12 p.m.

1. General Basiness of the Association.

2. The following gentlemen will be proposed as Honorary Members of the Asso-

ciation :

Staff-Surgeon Baron Mundy, M.D.

Sir James Clark, Bart.
John D. Cleaton, Esq.

Ludwig Meyer, M.D.
Robert Dunn, Esq.

in. AFTEBNOON HEETING OF THE ASSOCIATION, at 2.80 p.m.
1. Address by Lockhart Robertson, M.D., President.

Papers will be read by —

Baron Mundy, M.D. — A Comparative Examination of the Laws of

Lunacy in Europe.

John G. Dayky, M.D. — On the Insane Poor in Middlesex^ and the

Asylums at Hanwell and Colney Hatch.

Harrington Tukb, M.D. — On Monomania^ and its Relation to the

Civil and Criminal Law.

The Hembera of the Association and their Friends will hold their ANNUAL
BINNEB at WILLISES BOOMS, KING STB&ET, ST. JAMES'S, at 7 p.m.

Members of the Profession desirous of admission into the Association are re-
quested to communicate with the Honorary Secretary.

HARRINGTON TUKE, M.D.,
37, Albbmarlb Strrbt, W. ; Honorary Secretary,

lOM June, 1867.

To. 68. Hew SeriM, Vo. 87.)

THE JOIJBNAL OF MENTAL SCIENCE, OCTOBEB, 1867.

^Published by auihoriiy of the Medie(hP»yeholoffical Aasoeiation,"]

CONTENTS.

PART I. -ORIGINAL ARTICLES.

PAOB

Lockhart Bobertson, U.D. Cantab.— The Care and Treatment of the

Insane Poor ...... 289

rringtou Tnke, M.D., M.B.C.P.<— On Monomania, and its Relation to the

Civil and Criminal Law ..... 306

Ln G. Bavey, M.D. St. And., M.B.C.P.L. — On the Insane Poor in Middlesex,

and the Asylums at Hanwell and Colney Hatch . . .314

"on J. Mnndy, U.D. — A Comparative Examination of the Laws of Lunacy

in Europe ...... 319

^ W. G. Davies, B.D. — How the Extension of the Organism in three

Dimensions is realized ..... 325

I Velocity of Nerve-Force ..... 331

;ar Sheppard, U.D. — CUnieal Cases, Some further Observations in reply
to Certain Strictures upon the Treatment of a certain class of Destruc-
tive Patients ........ 334

PART ll.-REVIEWS.

la Folic Raisonnante et de I'importance du delire des actes pour le diag-
nostic et la M^decine legale. Par A. Bbibbbb db Boismont. Paris,
1867 ......... 341

agural Address delivered to the University of St. Andrew's, February Ist,

1867. By John Stuart Mill, M.P., Rector of the University . 348

erpta from the Annual Reports for 1866 of the County and Borough

Lunatic Asylums and Lunatic Hospitals of England and Wales 353

ii Contents,

PART Ili.-QUARTERLY REPORT ON THE PROGRESS OF PSYCHOLOGICAL

MEDICINE.

Editorial Note • . . • • ^;p

PART IV.-NOTES AND NEWS. -

Proceedings at the Annual General Meeting of the Medico-Psychological
Association, held at the Royal College of Physicians, on Wednesday,
31st July, 1867, under the Presidency of Dr. C. Lockhart Robertson.
Annual Dinner of the Medico-Psychological Association — Session
extraordinary of the Medico* Psychological Society of Paris, held
August, 1867, under the presidency of M. Paul Janet, Member of
the Institute of France. — The Asylum Cottage at the Paris Exhibition.
— An Unlicensed Asylum at Aldringham. — Statistics of Suicide. —
Publications, &c.. Received, 1867. — ^Appointments. — Obituary . 380—435

Notice to Correspondents . . . . . . 436

List of Members of the Medico-Psychological Association . . . i

No, 64 (new series No, 28) mil he published on the

1st ofJantMriff 1868.

THE JOURNAL OF MENTAL SCIENCE.

[Published hy Authority of the Medico-Psychological Association.']

No. 63. """^No.™ OCTOBER, 1867. Vol. XIII.

PART I.— ORIGINAL ARTICLES.

The Care and Treatment of the Insane Poor. By C. Lockhart
Robertson, M.D. Cantab., President of the Medico-Psycho-
logical Association.

{Read at the Annual Meeting of the Medico- Psychological Association, held at
the Royal College of Physicians,, July *6\st, 1867.)

'* Insane persons are everywhere regarded as proper objects of the care of the
State." — John Stuart Mill,

" Our present business is to affirm that Poor Lunatics ought to be maintained
at the Public Charge. I entertain, myself, a very decided opinion that none of
any class should be received for profit ; but all I hope will agree that Paupers at
any rate should not be the objects of financial speculation." — JJord Ashley,
(Speech in the House of Commons, 6th June, 1845.)

Among the many social problems included in the domain of
Medico-Psychology there is none of more importance, or more inti-
mately related to the duties of the community, than that of the Care
and Treatment of the Insane Poor. At this time, moreover, it is
the subject of much discussion in the general and medical press.
I do not therefore think, that I shall otherwise than meet with your
approval, if I use this present opportunity, which I owe to your
favour, to review the several relations of this grave social question.

In England our existing arrangements are only of twenty years'
standing, and owe their origin, as you are all aware, to the intro-
duction into the House of Commons by the Earl of Shaftesbury
(then Lord Ashley) of the Lunacy Act, 1845, which transferred to
the present Lunacy Commission the supervision of the insane poor
throughout England and Wales.

The condition of these patients previous to the passing of the

VOL. XIII. 21

290 The Care and Treatment of the Insane Poor; [Oct.,

Lunacy Act, 1845, is detailed in the 'Report of the Metr(ypolitan
Commissioners in Zu?tacy' (1844), who had for the first time been
authorised by the 5 & 6 Vic, c. 87, to inspect the condition of the
various public and private asylums throughout England and
Wales.*

It is not within my present purpose to relate again the tales of
misery and neglect recorded in this official report.. Suffice it, that
their investigations enabled the MetropoUtan Commissioners to
make those suggestions for the amendment of the law, which were
embodied in the Lunacy Act, 1845, and form the basis of our
present arrangements for the care and treatment of the insane poor.

The leading principle asserted in the Lunacy Act, 1845, as it
relates to the care and treatment of the insane poor, is, that the
permissive power to justices given by the 48 Geo. UI, c. 96, to
build county asylums, and which led to the erection of the seven
asylums for Nottingham, Bedford, Norfolk, Lancaster, Stafford,
Cornwall, and Gloucester, containing in all only 1500 beds, should
be compulsory, and that each county in England and Wales should
under the authority of the Quarter Sessions be compelled to make
provision for the care and treatment of its insane poor. Another
principle was, that the whole detail of these arrangements should
be controlled by the Justices of the County under the general super-
vision of the Commissioners in Lunacy. The medical character of
these asylums, as hospitals for the cure of mental disease, was for the
first time formally asserted, in their being placed under the govern-
ment of a resident medical superintendent. The subsequent Lunacy
Acts, relating to the care and treatment of the insane poor, which
have been passed, viz. the ' Lunatic Asylums' Act, 1853/ and the
' Lunacy Acts' Amendment Act, 1862,' are simply amplified details of
these principles. The time has now arrived when these legal enact-
ments might most wisely be consolidated into one intelligible statute.

The following table shows the number of pauper lunatics and
idiots chargeable in England and Wales at the decenniums 1847,

1867, and 1867 :—

^ * The foUowing was the numher of pauper lunatics chargeable in Angusti
1843, with their place of maintenance : —

MALE. 7BMALB. TOTAL.

In County Asylums 1,670 1,855 3,525

In Licensed Houses 1,059 1,239 2,298

In Workhouses 1,813 2,250 4,063

In Private DweUings 2,204 2,702 4,906

Total 6,746 8,046 14^792

Population of England and Wales (estimated) 16,000,000

Number of Pauper Lunatics and Idiots to Population, 1 in 1066

67.]

iy Djeu C. Lockhabt Bobektson.

291

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292

The Care and Treatment of the Insane Poor ; [Oct.,

I purpose to-day, to offer a few remarks for your consideration, on
the care and treatment of the insane poor in the three places of
maintenance in which we now find them, viz. : —

I. The Insane Poor in Public Asylums.
II. The Insane Poor in Workhouses,
III. The Insane Poor in Private Dwellings.

The following table shows the relative proportions in which the
insane poor are distributed in these three divisions in England and
Wales, in Scotland, and in Ireland : —

Tahle showing the Distribution per cent, of Pauper Lunatics and
Idiots in England and Wales, in Scotland, mid in Ireland, on the
\st of January, 1867.

Where maintained.

In England and In Scotland of In Ireland of
Wales of every every 100 every 100
100 there are there are there are

In Public Asylums . . 58*0

(County and District, and
Lunatic Hospitals.)

In Private Licensed Houses 2*5

In Workhouses . . . 24*0

In Private Dwellings . . 15*5

100-0

43-0

100
18-5

28-5
100-0

600

6-0

34*0 (including

gaols.)
none.

100-0

I. The Insane Poor in Public Asylums,

I begin my subject with a few remarks on the care and treatment
of the insane poor in public asylums. I do not feel called upon
from this place (nor does time admit) to enforce and illustrate the
incontestable superiority of public asylums for the care and cura-
tive treatment of the majority of the insane poor to either work-
houses or private dwellings. Yet in here recording the untold
success which has followed the efforts of the legislature since 1845
to ameliorate the condition of the insane poor through the com-
pulsory erection of county asylums — a success which led a recent
Harveian orator to call the sight of one of our English county
asylums ' the most blessed manifestation of true civilisation that the
world can present,' I cannot refrain from adding my humble word of
praise to the memory of one

Of the simple great ones gone
For ever and ever by

to that of my revered friend John Conolly, whose work of

1867.] by Dr. C. Lockhart Robertson. 293

freeing the insane from their restraint, and of thereby founding the
English School of Psychological Medicine, preceded the legislation
promoted by the Earl of Shaftesbury, and ensured the success of
these enactments.*

Dr. Conolly's four Annual Eeports of the County Lunatic Asylum
at Hanwell for 1839, 1840, 1841, 1842, still form the groundwork
of our treatment of the insane poor in the English county asylums,
while these asylums themselves — whose fame (I may be permitted to
say) based as it is on the successful appHcation of the EngUsh non-
restraint system has gone forth into the whole civilised world, and
thus brought rescue to the most suffering and degraded of our race —
stand throughout this fair land imperishable monuments of the

• " In Juue, 1839, Dr. ConoUy was appointed resident physician at HanweU. In
September he had abolished all mechanical restraints. The experiment was a
trying one, for this great asylum contained eight hundred patients. But the ex-
periment was successful ; and continued experience proved incontestably that in
a weU-ordered asylum the use even of the strait- waistcoat might be entirely dis-
carded. Dr. Conolly went further than this. He maintained that such restraints
are in all cases positively injurious, that their use is utterly inconsistent with a
good system of treatment ; and that, on the contrary, the absence of all such
restraints is naturally and necessarily associated with treatment such as that of
lunatics ought to be, one which substitutes mental for bodily control, and is
governed in all its details by the purpose of preventing mental excitement, or of
soothing it before it bursts out into violence. He urged this with feeling and per-
suasive eloquence, and gave in proof of it the results of his own experiment at
Hanwell. For, from the time that all mechanical restraints were abolished, the
occurrence of frantic behaviour among the lunatics became less and less frequent.
Thus did the experiments of Charlesworth and Conolly confirm the principles of
treatment inaugurated by Daquin and Pinel; and prove that the best guide to
the treatment of lunatics is to be found in the dictates of an enlightened and re-
fined benevolence. And so the progress of science, hy way of experiment, has led
men to rules of practice nearer and nearer to the teachings of Christianity. To
my eyes a pauper lunatic asylum, such as may now he seen in our English counties,
with vts pleasant grounds, its airy and cleanly wards, its ma/ny comforts, and wise
and kindly superintendence, provided for those whose lot it is to bear the double
burthen of poverty and mental derangement — I say this sight is to me the most
blessed manifestation of true civilisation that the world can present,

" This result we owe to the courage and philanthropy of such men as Pinel and
ConoUy. Pinel's large acquirements and practical intellect would alone have
availed nothing; his first step would never have been taken but for the generous
impulses of a feeling heart and courageous spirit. Conolly *s experiment at
Hanwell would have been foiled by opposition and discouragement, had he
not been sustained by a spirit of earnest benevolence towards his unhappy
patients.

" The spirit which animated these two men is the spirit without which much of
the progress of practical medicine would have been impossible. For, however
diverse may be the intellectual powers that find their several fit places in the
study and practice of medicine, there is but one right temper for it — the temper
of benevolence and courage ; the temper in which Larrey invented the ambulances
volanteSf that he might bring help to the wounded under fire ; the temper in
which physicians have devoted themselves to the study of the plague and other
infectious fevers ; that same temper which has originated and sustained the
highest Christian enterprises, and which ennobles any man who, possessing it,
with an honest and true heart does his duty in our profession.*' — The Harveian
Oration^ 1866, hy Oeorge U. Paget, M,D, Cantab,

294? The Care and Treatment of the Insane Poor; [Oct.,

statesman to whom thej owe their origin^ and of the physician who
asserted the great principle on which the treatment within their
walls is founded.

During the twenty years (1847-67) the Lunacy Act, 1845, has
been in force, the number of beds in the county asylums in England
and Wales has increased from 5,500 to 26,000. In 1847 there
was provided in the public asylums accommodation and means of
treatment for 36 per cent, of the pauper lunacy of the country ; in
1867 we have advanced on this state of things, and provided for 60
per cent, of the whole pauper lunatics and idiots chargeable. During
this period the total number of pauper lunatics and idiots has increased
from 17,952 to 42,943, while in 1847 1 in every 880 of the whole
population was a pauper lunatic. This proportion is now, in 1867,
1 in every 494. I do not attribute these numbers to any actual
increase of insanity, but rather to the fact of the more accurate
returns which are now made of the pauper lunacy of the country,
and also in some degree to a number of persons in the lower middle
class, successfully contriving to evade the restrictions of the Poor
Law, in order to procure for their insane relatives treatment in the
county lunatic asylums. This opinion of the absence of any positive
increase in the lunacy of the country is further supported by the
lelative proportion of private patients to the population during the
same period. In 1847, 1 in 3913 was certified as a private lunatic;
in 1867, 1 in 3577.

Thus, I think I am justified in saying that we see the limits of
our labours in providing for the care and treatment of the insane
poor ; and, further, that we have nearly gained the^desired end. It
is allowing a wide margin in our calculations for the future if we
place the possible total number of pauper lunatics and idiots at
1 in 400 of the population. This would give on a population of
22,000,000 about 55,000 pauper lunatics and idiots.

Here the question at once arises. For how many of these 55,000
pauper lunatics and idiots will public asylum accommodation be
requisite ? The table I have given above shows the existing pro-
portions in England, in Scotland, and in Ireland, in which the Insane
Poor are divided between the pubhc asylums, the workhouses, and
the private dwellings.

In calculating the wants of the future it is at once necessary to
determine whether this proportion in the distribution of the insane
poor — the result of the last twenty years' experience — ^is a fair and
proper one ? My own opinion is that the English proportion is, on
the whole, a fair standard, and that we may safely assume for our
future guidance that the pauper lunatics and idiots (whom I place at
the ultimate average of one in 400 of the population) may with
due consideration of all their claims and requirements be thus
distributed : —

1867.] ly De. C. Lockhart Bobebtson. 295

In Public Asylums, 60 per cent.

In Workhouses, 25 per cent.

In Private Dwellings, 15 per cent.

And if, as we hope and believe, the population continue to increase,
and if mental disease, as we fear it will for many generations, increase
itt proportion with the population, it must be remembered that wealth
increases in a tenfold degree, and that it cannot be otherwise than
the duty of a Christian government to chai:ge on this marvellous
wealth the cost of the care and treatment for those who have fallen
by the wayside, poverty-stricken and mentally wounded in the
strife.* During the last ten years, for example, the rental in the
county of Yorkshire, exclusive of the represented boroughs, has
increased by one million and a half. Is it an unreasonable burthen
on this increase to add another penny to the county rate to build —
as the justices are about to do — two new asylums for the insane poor
of this great county ?

We should thus require, with a population of 22,000,000,
33,000 beds in the public asylums. Of these 26,000 are already
provided. The problem then is not so difficult to solve as certain
recent writers would lead the public to imagine. The machinery
which has so successfully and to the satisfaction of all classes of the
jcommunity, provided in twenty years the 26,000 beds may I think
fairly be trusted to add 7,000 more to the number.

How best can these 7,000 beds be procured ? First in order
comes the question of the possible increase in size of the county
asylums. Many years ago the opinion prevailed that 800 patients
were ample for the care of one superintendent. This number has
now gradually been allowed to increase to 600, and it is apparently
still on the increase. If our public asylums were like those in
Germany and consisted of two distinct establishments, the Heil-
anstalt and the Pfleganstalt (although there also this division is being
by the force of events broken through), there could be no question
whatever that 800 recent and acute cases of mental disease would
tax the efforts of the most unwearied medical superintendent. But
in estimating the fit numbers for an English county asylum it must
be remembered, that these hospitals are of a mixed character and
include a large proportion of incurable lunatics, whose treatment,
speaking generally, is a matter of organized system rather than of
individual observation. My own experience coincides with the
general result arrived at by force of circumstances, that a county
asylum with 600 beds may perfectly well be managed by one medical
superintendent and under one authority. Indeed, I go further, and
say that an asylum with 600 patients will in most points be better
organized, at the same cost per bed, than a smaller one of 300. In
asylums containing a large number of chronic cases I would even

296 The Care and Treatment of the Insane Poor ; [Oct.,

allow that 800 patients might with the aid of two assistant medical
officers be treated. Beyond this number I should be most unwilling
to go. The experience of all larger asylums shows an increase of the
average cost, and also, unquestionably, a decrease in the comfort and
wellbeing of the patients, with a further increase of number.

The present average accommodation in the English county asylums
is about 400. An average increase of from 200 to 400 beds in these
asylums would then entirely solve the problem of public asylum
accommodation for this generation. Possibly the lunatics of the
future may attain their city of refuge in new Gheels ; sufficient for
our present purpose be the wants of this generation. Enlargements
have been made in several asylums, owing to our progressive views of
asylum architecture, to the manifest improvement of the original
structure, as in the appropriating to the patients^ use of the Medical
Superintendent's quarters, the central chapel, &c., &c. ; in others
detached blocks have been built of a more domestic and inexpensive
style. In either case experience has amply shown that these addi-
tions may be made for one third of the original cost ; that is, while
the average cost of asylum construction has been £170 per bed
(including furnishing and every item), the alterations and enlarge-
ments I have spoken of have been completed at the Devon, at
Chester, at Hayward's Heath, &c., from £50 to £60 a bed. A. very
desirable means of relieving the county asylum is one now in
progress, viz., the building of separate borough asylums, such as
Leicester, Norwich, &c., &c. ; when, instead of these boroughs
paying rent to the county asylum for the beds they occupy, they
will without further cost have an asylum of their own, and have the
entire control of all relating to their patients.

In larger and more populous counties, like Lancaster, Surrey, and
Chester, a territorial cUvision of the county has been adopted and
which is much to be preferred, on the ground alike of proper
management and economy, to the huge asylum extensions of Han-
well, Colney Hatch, and Kent.

II. The Insane Poor in Workhouses,

On the 1st of January, 1847, there were 4631 pauper lunatics
and idiots confined in the workhouses in England and Wales.

On the 1st of January, 1857, their number rose to 6800 ; and
on the 1st of January, 1867, it had increased to 10,307. In 184^7,
they formed 25 per cent, of the total number of pauper lunatics ; in
1857, 25 per cent,; in 1867, 24 per cent. Thus, although the
total number of pauper lunatics chargeable has trebled during the
twenty years 1847-67, the proportion of those confined in work-
houses has not increased.

By the 111th section of the Lunacy Act, 1845, the Commissioners
in Lunacy were authorised to visit (and report to the Poor Law

1867.] ly Dr. C. Lockhart Eobertson. 297

Board) all lunatics and idiots confined in the workhouses in England
and Wales.

We have, in the ' Further Report of the Commissioners in Lunacy^
a general statement of the position in 1847 of the insane poor
confined in the workhouses. This was the first occasion on which
any legal inquiry had been made as to the condition of the lunatic
inmates of these houses. Considerable discrepancy prevailed in the
numbers returned by the Poor Law Board, and those actually found
by the Visiting Commissioners. The majority of these lunatics
were idiotic and demented, but some of the severe and more recent
forms of insanity were also met with by the Commissioners.

In 1859 the Commissioners in Lunacy published a detailed report
on the condition of the lunatic inmates of workhouses.** This report
gave a most unsatisfactory account of their state and treatment.
The state of these patients was also fully investigated by the Select
Committee on Lunatics in 1859, and an effort was made ^ in the
Lunacy Act^ Amendment Act, 1862, to regulate the conditions
mider which pauper lunatics are now detained in workhouses.
Thus section 20 provides, that no lunatic or alleged lunatic, shall
be detained beyond fourteen days in a workhouse, unless the medical
officer of the parish give a certificate in writing, that he is a proper
person to be kept in a workhouse, nor unless the accommodation in
the workhouse is sufficient for his reception. It is further provided
by section 21 that a quarterly return shall be sent by the medical
officer of the workhouse to the clerk of the union, who is required
to forward copies to the Commissioners in Lunacy and to the clerk
of the Visitors of the County or Borough Asylum. The 30th
section gives the Commissioners in Lunacy power at their visits to
send any pauper lunatics detained in workhouses to the county
or other asylum without further order or certificate — a most valuable
provision. The 37th section requires the Visiting Committee of
the Board of Guardians to record, at least once a quarter in the
visitors' book, such observations as they may think fit to make
respecting the dietary accommodation and treatment of the lunatics
or alleged lunatics in the workhouse, which book shall be laid
before the Commissioners at their next visit by the master.

The Commissioners manage apparently to visit the 10,000 lunatics
and idiots detained in the 688 workhouses in England and Wales at
least once in three years; taking the 100 workhouses which have
separate wards for the insane once a year, and the others at least
once in three years.

On the 1st of January, 1867, the numbers had risen from 6800
to 10,307, and again the Commissioners in their last report furnish

• * Supplement to the Twelfth Report of the Commissioners in Lunacy to the
Lord CJhanceUor.' Ordered, by the House of Commons to he printed, Ihth April,
1869.

298 TAe Care and Treatment of tie Insane Poor; [Oct.,

us with an insight into the present condition of these patients. The
same fact is recorded that the insane in the small country workhouses,
who are mixed with the other inmates, are generally in a favorable
condition. Employed with the rest indoors, or in the garden and
fields, and enjoying often some indulgences of diet, the idiotic and
demented patients in these houses are placed in as favorable con-
ditions of existence as can be expected, or as is necessary for their
wellbeing. Likewise, in some of the larger town workhooses^ where
special lunatic wards have been arranged, the condition of the
patients is very satisfactory. To this, however, there are marked
and numerous exceptions in the workhouses in town districts, where
the numbers of the insane poor are neither small enough for the
domestic treatment of the country unions nor large enough for
the asyliun arrangements adopted in the large houses, and where
patients requiring asylum treatment are detained without anything
of asylum comforts, where there are cheerless rooms, insufficient
and incompetent attendance, a low diet, no records of the simplest
kind, and no provision whatever for healthful exercise of mind or
body.

The Poor Law Board continue to evince the greatest solicitude
for the welfare of the insane poor, and give their uniform support to
the recommendations made by the Commissioners in Lunacy at
their visits. The change, since 1847, in the condition of the
insane poor in workhouses has been on the whole a progress. The
guardians and medical officers take a more hberal view of their obliga-
tions towards these patients, and a more uniform practice has been
enforced of sending the recent and acute cases at once to the county
asylum for treatment, the most important point of all connected with
the care and treatment of the insane poor.

The experience of the last twenty years places the treatment in
the public asylums beyond all cavil or comparison with similar
attempts in workhouses or in private dwellings, alike for all
cases of recent mental diseases, and for the majority of those of
chronic mania and dementia, with their natural complications of
paralysis, softening of the brain, epilepsy, &c. With every desire to
reduce the numbers of the insane poor requiring the accommodation
of the county asylums, I do not think, as I have already said, it can
ultimately be placed at less than 60 per cent, of the total number of
pauper lunatics and idiots. All efforts to reduce this number by send-
ing back cases of chronic mental disease to the workhouses, as has
been done in numerous asylums, has resulted in a lamentable failure,
and in the return of the patient, after a limited time, with a marked
increase of his disease. This is so far evidence in favour of the
present English standard of the proportion of the insane poor (60
per cent.) requiring asylum accommodation, and that we do not
(as has recently been often asserted) indiscriminately and without

1867.] hy De. C. Lockhaut Eobbetson. 299

necessity, sequestrate the insane poor. This is a point on which I
am disposed strongly to insist.

Yet, on the other hand, experienbe leads me to say that the aged, im-
becile, and demented lunatics prefer the workhouse to county asylums,
partly from the greater freedom from discipline (from enforced
order and cleanliness, baths, &c.) which they enjoy, partly from the
association with sane persons there instead of the insane, and partly
because it is situated nearer their own parish and family. It may
be a want of judgment and taste, but the truth certainly is that the
insane poor who are sufficiently sane to argue the point, the aged,
the infirm, the epileptics, the imbeciles, &c., are constantly asking to
be sent back to the union. I am sure the experience of the medical
superintendents of our large asylums will confirm this fact.

I would say, speaking generally, that 25 per cent, of the pauper
lunatics and idiots chargeable may, with great relief to the wards of
the county asylum, and with satisfaction to themselves and their
friends, be kept under proper restrictions in the workhouse. The
mixing there with persons of sound mind is a comfort much ap-
preciated by this class of patients, as also the greater freedom, the
facility of visiting old friends and associations and such like. In
country districts, the workhouses would thus prevent the constant
tendency to the accumulation in the wards of the county asylums of
harmless and incurable lunatics. A similar relief was contemplated
in, rather a different way by the 8th section of the Lunacy Acta'
Amendment Act, 1862 ; but the wording of the clause is so obscure
that the Attorney and Solicitor-General advised in May of this year
" that furthCT legislation is needed, in order to define more clearly
the true position of chronic lunatics removed to workhouses, and
of the visitors, guardians, and others with respect to their
lunatics.*^

When by sucli high authority further legislation on this point is
stated to be necessary, I may perhaps be permitted to say, that in
order to place the arrangements for the care and treatment of the
insane poor in workhouses on a satisfactory and permanent basis, it
is above all things necessary that one system and authority should
regulate the same.

Parliament has already in theory confided the charge of the insane
poor to the Justices of the Peace, under the supervision of the Com-
missioners in Lunacy. I would urge that this theory be put in
practice. To this end I would suggest : —

1. That it be illegal to detain any lunatic or idiot in a workhouse
without the same medical certificate and a justices^ order, as is re-
quisite for admission into the county asylum, and that copies should
be transmitted by the clerk of the union to the Commissioners in
Lunacy, and to the visitors of the county asylum.

2. That the visitors should depute the medical superintendent, or

300 The Care and Treatment of the Insane Poor; [Oct.,

one of the medical ofiBcers of the county asylum, to visit the work-
houses in the county at least once a year,* to arrange for the inter-*
change of suitable cases, and to report to them on the condition
and treatment of the insane inmates; such report to be submitted to
the Sessions, with the document relating to the management of the
county asylum.

3. That the case books and statutory records of the workhouses,
so far as relates to the care and treatment of the insane poor, be
assimilated to those in use in the county asylums.

Similar provisions were long ago recommended by the Earl of
Shaftesbury in the speech (6th June, 1845), in which he introduced
the Lunacy Act, 1845, into the House of Commons : —

''In erecting (he said) new asylums, and providing farther ac-
commodation where it is required, regard should be had to the pro-
portion of curable and chronic lunatics, I purposely avoid the use
of the term incurable. Separate buildings, I propose, should be
provided for chronic lunatics at a less cost, and parts of the work-
houses, with the consefit of the Poar-Law Commissioners, may he
adapted, in which case they are to he separated from the other part
of the building^ and to he deemed county asylums,"

Placed on this footing, the workhouses might in the majority of
the country districts become valuable means of relieving the over-
crowding of the county asylum, and, where the workhouses cannot
be used for this purpose, there is no doubt that auxiliary asylums
of an intermediate character between the workhouse and the asylum,
as recommended by the Commissioners in their last report (1867),
might be built and fitted for about £80 a bed. Such auxiliary
asylums would even more efiBciently relieve the overcrowding of the
county asylum, and could be conducted as economically as the
lunatic wards of the workhouses.

For London and Middlesex the Metropolitan Poor Act 1867 pro-
vides district asylums for the reception and relief of the insane poor.
1 believe there are about 3000 insane inmates of the metropolitan
workhouses for whom provision is thus to be made, and a consider-
able number of the inmates of Hanwell and Colney Hatch might
yearly be drafted into these district asylums as they pass into the
chronic and harmless stages of the disease. Such district asylums
would essentially resemble the German Pfieganstalten, or houses of
care, as opposed to the asylums or hospitals for cure. They ought
not to contain more than 1200 beds each. Their construction
should be of the most simple kind ; probably detached three-storey

* This would occupy about a fortnight off and on in the year, and would form
a healthful change of work, and be alike beneficial to the medical superintendent
and to the inmates of the Unions whom he would visit. Of course this arrange-
ment implies the presence at the county asylum of one or more assistant medical
officers — a point much insisted on by the Commissioners.

1867.] hy Dr. C. Lockhart Robertson. 301

buildings, with dormitories and dayrooms on the pavilion principle,
will be found the best method of construction.

The act provides for the election of an independent board of
management, partly chosen by the vestries, partly nominated by the
Poor-Law Board, to whom great authority for the erection and sub-
sequent conduct of these district asylums is entrusted.

Connected with this division of my subject is the question of the
care and treatment of the idiot children of the poor. Of the
40,000 pauper lunatics and idiots in England and Wales, 10,000 are
idiots from birth. These idiots are maintained partly at home, partly
in the workhouse, and the more hopeless and troublesome are sent to
the county asylum. As every experienced superintendent will admit,
nothing can be more detrimental to their chance of improvement
than to place these congenital idiots in the w^ards of a lunatic
asylum ; still more unsuitable are those of the workhouse. In the
private dwellings of the poor the difficulties are even greater. The
treatment of lunatics and of idiots is distinct in principle and in
practice, and they cannot be dealt with under one system. The
remedy Ues in the establishment in the several districts of England
of idiot asylums. Probably one for each of the eleven poor-law
districts would suffice.

By extending the provisions of the lunacy acts to the erection
of these idiot asylums, and to the cost of maintenance there, no
new machinery would be requisite. It needs no words of mine to
urge the claims of the idiot — of those who cannot plead for them-
selves— to a share of the gifts of fortune and of heaUng which have
been so richly poured on this generation. We have already at
Earlswood a model idiot asylum, and marvellous proof, what wise
treatment can effect to the amelioration of this sad affliction. An
idiot asylum with 400 beds in each of the eleven poor law districts,
and which might be built at £80 a bed, would amply meet this
I)ressing want, and so far lessen the per-centage of pauper lunjitics
and idiots requiring care and treatment in the county asylum, in the
workhouse, and at home.

III. The Insane Poor in Private Dwellings.

In England and Wales 15*5 per cent, or upwards of 6000 of
the insane poor are boarded out, chiefly with their relations, under
the authority of the Boards of Guardians and the certificate of their
medical officer, but without any magistrate's order to legalise their
detention. A quarterly list of these patients by the medical officer
of the district, stating the form and duration of the disease, and the
date of his quarterly visit, &c. &c., is sent by the clerk of each
union to the visitors of the county asylum, and to the Commissioners
in Lunacy. They are chiefly cases of congenital idiocy and de-

302 The Care and Treatment of the Insane Poor; [Oct.,

meatia. The allowance for their maintenance averages 6d. a day.
No official inspection of their condition is made by the Commis-
sioners in Lunacy, and the little that is known of their condition is
not encouraging as regards the extension of the present system.

In Scotland there is an excess of thirteen per cent, on the English
proportion in th6 number of pauper lunatics treated in private
dwellings. These numbers tend, however, towards a steady decrease.
Thus, while in the last eight years there has been an increase of 969
pauper patients placed in pubUc asylums, there has been a decrease
in the same period of 216, or thirteen per cent, in the number of
those treated in private dwelUngs. Another such eight years' ex-
perience would bring the proportion of cases, thus treated, down to
the English average.

In Scotland, where this system has been highly lauded and offered
for an imitation as the remedy in all our difficulties, the care and
treatment of the insane poor in private dwellings is carried out under
the official authority and inspection of the Lunacy Board. Insane
paupers may there either be boarded singly in a labourer's cottage,
or these cottagers may procure (without fee) a license from the
Lunacy Board"*^ to receive patients to the number of four. The
average parochial allowance for lodging and maintenance is sixpence
a day — about the same as in England. The guaranteesf provided
for the protection of the subjects of these humble lay speculators
in lunacy are a quarterly visit by a medical man, a half yearly visit
by an inspector of poor, and an annual visit by one of the deputy
commissioners, unless in Orkney or Shetland, or in the Western
Isles, where this official visit is paid once in two years. According
to Dr. Mitchell,! the great majority of pauper patients in private
dwellings consist of " thefatuov>s and the idiotic, that is, of mindless
persons whose appreciation of liberty cannot he great or strikingly
shown,'^ and patients in this condition (he reports) should always,
in his opinion, constitute the majority of single patients. I think
the existence of the system is condemned by this official admission.
The demented and the idiotic [mindless persons) cannot complain.
They neither remember the restraints placed on their liberty, nor the
neglect and want to which they may have been subjected. Their
power of contributing by their labour to the income of those to
whom they are farmed out is small. There is little in the Scotch
practice but the sixpence a day between them and neglect and want.
The amount of official inspection they receive cannot be worth
much. I would just ask you to recall the demented and fatuous in-
mates of one of our county asylums, with their depraved habits and

* 25th and 26th Vict., cap. 54, § 5.

t • Ninth Annual Report of General Board of Commissioners in Lunacy for
Scotland, 1867.'
X * General Reports on Lunatics in Private Dwellings, 1867.'

1867.] hy Dr. C. Lockhart Eobertson, 803

many wants, and to remember the daily, hourly care required to
keep them decently clean, and to retain some faint image of
humanity and civilisation around them, in order to realise what their
condition must be when all the costly remedial agents of the asylum
are once withdrawn. It needed not the graphic detail given by the
writer of an oft quoted paper, ^ Gheel in the North,^"*^ to realise how
far removed from sober truth are the pictures of rural bliss — of
the demented and mindless patient in the quiet enjoyment of the
ever-shifting busy scene in the cottage kitchen, and of the freedom
and kindly guardianship there enjoyed — which are yearly chronicled
iu the appendix to the Scotch lunacy commissioner's reports.

The principle asserted by the Lunacy Act of 1845, that the insane
poor should not be the objects of financial speculation, but that
they should be maintained and treated at the public charge, has
been throughout consistently adhered to by the English commis-
sioners.! The recent practice of the Scotch commissioners in
licensing private pauper houses of three or four inmates to ignorant
and needy persons is a retrograde step in the care and treatment of
the insane which I think we shall all condemn.

I cannot then cite the theory or practice of the Scotch Lunacy
Board, in perpetuating the practice of farming out for profit, singly
or in parties of four, to the care and treatment of the peasantry, the
insane poor as one at all worthy of farther consideration on our
part. The pressure on our English asylums will not, I am sure, so
far as the English Commissioners in Lunacy or the Justices in
Quarter Sessions are concerned, be relieved by the re-introduction in
this most objectionable form of the principle of lay speculation in
pauper lunacy.

While thus condemning entirely the Scotch practice of boarding
the insane poor with the peasantry in the villages throughout the
country, I am very far from asserting the opinion that all the insane
poor without exception ought to be treated in the county asylum or
in the workhouse. A certain proportion (I have placed it at 15 per
cent.) might, with increased enjoyment of life, be restored to their
own families, were suitable provision made for their care and main-
tenance. As medical superintendent of a large county asylum I am
weekly receiving applications to allow patients to return to their

» "Gheel in the North."—* Journal of Mental Science/ July, 1866.

t " If to this estimate of the most recent additions to the public accommodation
provided for pauper lunatics we apply the ratio of increase in the number re-
quiring accommodation observable during the last year, some conclusion may be
formed as to the period for which these additional beds are likely to be found suf-
ficient to meet the constantly increasing wants of the country, and how far they
will tend towards the object we have sought most anxiously to promote ever since
the establishment of this Commission, nftmely, the ultimate closing of Licensed
Bouses for Pauper Lunatics" — ' Twelfth Report of the Commission in Lunacy to
the Lord Chancellor, 1858/

304 The Care and Treatment of the Insane Poor ; [Oct.,

homes, and though many of such cases are unfit to be discharged,
others certainly might under proper restrictions be so restored.
What is required to give this plan a fair trial is some simple
organisation connected with the county asylum, similar to the per-
missive powers which now exist of allowing patients to be tem-
porarily absent on trial, with a weekly allowance. Were this
permissive power converted into a permanent system of home treat-
ment for the insane poor, great comfort would result to many
families in having their afilicted loved ones again with them."*^ If the
visitors of the county asylum had the power of boarding with their
relatives, at an allowance not exceeding the asylum maintenance
rate, patients selected for this home treatment, many applicants would
be found, and the confidence of the poor in the authorities of the
asylum would be greatly increased. The only machinery necessary
would be to add a relieving oflBcer to the staff of the asylum, for
the purpose of making a periodical visit and payments to these
patients. The medical practitioners in the district should be em-
ployed to make a quarterly medical report to the visitors, and
in exceptional cases further visitation could be made by the medical
officers of the county asylum. The certificates remaining in force
throughout the whole period, the patients could, without further
delay or trouble, be brought back to the asylum in any case of
relapse or other necessity.

Such a plan would ultimately supersede the present system in
England of boarding the insane poor in private dwellings under the
authority of the boards of guardians ; a system, although embraciug
15 per cent, of those chargeable, of the working of which very little
appears to be known, and that little, I fear, not much to its credit.

To pass here from these general statements to a little further
detail, I would take the couiity of Sussex, with which I am officially

* " I cannot bat think that fnture progress in the improvement of the treat-
ment of the insane lies in the direction of lessening the sequestration, and in-
creasing the liberty of them. Many chronic insane, incurable, and harmless, will
be allowed to spend the remaining days of their sorrowful pilgrimage in private
families, having the comforts of family life, and the priceless blessing of the ut-
most freedom that is compatible with their proper care. The one great impedi-
ment to this reform at present lies in the public ignorance, the unreasoning fear,
and the selfish avoidance of insanity. When knowledge is graduaUy made to
take the place of ignorance, then will a kindly feeling of sympathy for the insane
unite with a just recognition of their own interests on the part of those who re-
ceive them into their houses, to secure for them proper accommodation and good
treatment. Then, also, wiU asylums, instead of being vast receptacles for the con-
cealment and safe keeping of lunacy, acquire more and more the character of
hospitals for the insane ; while those who superintend them, being able to give
more time and attention to the scientific study of insanity and to the means of
its treatment, wiU no longer be open to the reproach of forgetting their character
as Physicians, and degenerating into mere house stewards, farmers, or secre-
taries."— ' The Fhynology and Pathology of the Mindy* hy Henry Maudtley^
M,D, Lond.

1867 J hy De. C. Lockhart ^obektsok. 305

connected, and therefore best cognisant. The population of the
county, according to the last census, and corrected to July, 1866, is
377,180. The total number of pauper lunatics on the Ist January,
1867, was 837, or 1 in 450 of the population. They were thus
distributed : —

Male. Female. TotaL IPer Cwt.

In the County Asylum at Hay-
ward's Heath . • .236 294 530 63*3

In Workhouses ... 76 99 175 %vo

Living with Priends • • 51 64 115 137

Boarded out in Private Dwell-
ings • • • • • 9 8 17 vo

Total . . .372 465 837 loo-o

We shall have at the county asylum about 700 beds when the
alterations in progress are completed, and the entire plan for the
enlargement of the asylum provides 800 beds, viz. 350 male, and
450 female. The original building, fitted and furnished for 450
patients, cost £175 a bed. The extensive enlargements and alte*
rations to adapt it to 800, will, while materially improving the
building and the facihty in working, be carried out, including
furnishing, for £60 a bed.

If, allowing for increase of population in the next twenty years,*
we place the inhabitants of the county at 500,000, we should,
taking 1 pauper lunatic and idiot to eveiy 400 of the population,
have in this period a total of 1250 to provide for. On the standard
which I have taken, of 60 per cent, requiring asylum treatment, 25
per cent, workhouse accommodation, and 15 per cent, being placed
in private dwellings, we should have a population of 750 at the
county asylum, 300 to be maintained in the workhouses, and 250
to be boarded in private dwellings with their friends. This, it is
evident, is allowing a wide margin in our estimate, both as regards
increase of population, and of the number of pauper lunatics and
idiots chargeable, which I hardly think can, even under any likely
circumstances, exceed 1 in 400 of the population.

We shall be able to receive the 750 at the county asylum.
There can be no great difBculty in finding proper accommodation
for 800 in the twenty-five workhouses in the county, and I believe
that 250 families may be found, able and willing to undertake the
care of their insane relatives, under the arrangements which I have
just sketched.

* In 1851 tbe population of the county of Sussex was 836,844, and In 1861
868,735, being an increase of 26,891 in the decennium. I am aJlowing in my cal*
eolations a pondble increase of 187|265 in the two decennioms.

VOL. xm. 22

306 Ofi Monomania, and its Relation to the Civil and [Oct.^

Yoa will thus see that I take a hopeful view of the future^ as it
relates to the care and treatment of the insane poor. The difficulties
which beset the path of the early asylum reformers^ have gradually
yielded to the progress of wiser and more humane sentiments/ and
it is only matters of detail that now remain for us to arrange in
order to complete and consolidate the working of the system inau-
gurated by the Lunacy Act^ 1845^ and sdready brought to so suc-
cessful an issue by the united labours of tne Commissioners in
Lunacy^ and of the Visiting Justices and ' Medical Superintendents
of the English county asylums. I "have thought that the oppor-
tunity which this day has given me would ' not be unwisely used in
reviewing, aided by the experience of the past twenty years, the
several details of this system as they relate to the present and
future treatment of the insane poor.

On Monomania, and its Relation to the Civil and Criminal Law.
By Haebington Tukb, M.D., M.E.C.P., Honorary Secretary to
the Medico-Psychological Association.

{Read at the Annual Meetituf of the MedicO'FtjfehoUmeal Auociation^
held ai the Boj/al College o/FhyHdans, July nsi, 1867.)

Ma. Peesidbnt and Gentlemen, — ^The fact of my having been
frequently summoned as a medical witness in the civil and criminal
courts of justice, in cases in which monomania has been alleged to
exist, and the examination of the evidence in two recent and im-
portant cases of disputed wills induces me to bring under the
notice of the Medico-Psychological Association the present practice of
the Courts in relation to monomania, and to attempt a concise
description of this form of disease for consideration and discussion.

I believe that much misapprehension has arisen and much mischief
has ensued from the fact that some medical authors entirely ignore,
and others vary in their acceptation of the well-known term mono-
mania, which, although of recent date and erroneous meaning, is
constantly used by our law writers, and has become ingrafted in the

/opular language of all the great countries of Europe.
We owe the first introduction of the word ''monomania'* to
Esquirol, and although it is interesting to trace the process of reason-
ing by which he arrived at the necessity of a new term to supersede
melancholia, yet we must recognise it as unfortunate that he should
have coined one so etymologically incorrect, and so much at variance
with the true description of the malady he intended to define.

|867.] CHminatLaw; ij^ Da. Harrington Tukb. 307

The ancient physicians divided the insane into two great divisions:
from the leading symptoms presented by the frenzied and distraught,
they called one form of disorder mania ; from a belief as to their
exciting cause, they classed all other forms of insanity under the one
generic name melancholia. The division thus made by these acute
observers, although erroneous pathologists, is exactly equivalent to
describing the disease as constituting a complete or a partial insanity,
and in that sense the words were understood. It is not necessary
to detain you with any attempt at proving this to have been the case ;
but the instance of monomania famiUar to us all, as mentioned by
Horace, and the forms of unsoundness of mind which Aretaeus has
described, demonstrate that melancholia was the term applied to
those forms of insanity in which the patient was still to some extent
in the possession of his reasoning power. In later years the term
melancAolia became significant of the existence of gloomy and distress-
ful impressions, and in this restricted sense it is employed by Celsus,
who does not, however, give any name to the remaining forms of melan-
cholia, or reasoning insanity, thus deprived of their distinctive title.
Esquirol, in his nomenclature of mental disorders, adopted the
division of Celsus, and divided melancholia, as that writer had done,
into two principal divisions. The one he called lypemania, the
insanity of grief, the atrabilis, or true melancholia of Celsus ; for
the other he ventured to do that from which Celsus shrank, and
coined the new word ''monomania.^'

The mischief done by this ill-chosen word became almost imme-
diately apparent ; and Esquirol himself, with the vanity of a neoloi
gist, in a note to one of the later editions of his work, drew attention
to its first development, without noticing the error he had himself
induced. He says, ^^ the French Academy have done me the honour
to adopt this word (monomania) into its dictionary .'' He does not
say that they define it as describing a disease in which one delusion
only is present ; translating, in fact, monomania ^ but of course being
in utter ignorance that such a disease is one which may be theoretic
cally possible, but, as far as I know, has never yet been seen, and
is certainly not stated to exist, even by the inventor of the term.
On the authority of the French academy, the word monomania,
however, became popularised, and has since been freely used as im-
plying the existence of a delusion upon one subject. I speak in the
presence of many of the first and most experienced psychologists of
Great Britain; and I believe they will concur with me in the opinion
that such a monomania is practically an unknown malady. Esquirol
himself is careful to define monomania, in a sense entirely subver-
sive of its etymological meaning ; he describes it as involving one or
a limited number of delmions ; and with further inconsistency he
implies that these delusions must be all of a cheerful character,
although there can be no reason why monomania, under his own-

308 On Monomania^ and its Relation to the Civil and [Oct.,

defiuition^ should not involve the most sad and depressing delusions.
The American writer, Dr. Bush, has appreciated this difficulty, and
has divided partial insanity into two divisions, to the first of which
he has given the far more distinctive appellation of tristomania, marked
by sad delusions ; the second he calls amenomania, characterised by
lively and cheerful excitement. The more etymologically correct
nomenclature of Bush is forgotten, the lypemania of Esquirol abso-
lutely ignored, but monomania is still in general acceptance, although
it expresses a disease that does not exist, and translated literally
can only lead to error. It is not surprising, then, to find that many
of our writers do not employ it at all ; that it is not found in our
records or case-books ; that some, as our late president, Mr. Com-
missioner Brown, define it as an insanity embracing a group of
symptoms arising from disorder of some special faculty of the brain;
that others confuse it with moral insanity ; and that judges, lawyers,
and juries, find themselves perplexed by the use of a term by medical
men which means so much more than its etymological signification ;
so very much more than its popular acceptation. I would specially
insist upon the importance of this last error. There is no greater
mistake that juries or judges can fall into than imagining that mono-
mania in a patient can exist, and at the same time perfect sanity
upon other subjects can be safely assumed j and yet tins error is the
most common of all.

A purist in language must of course decline to use the word mono-
mania as meaning anything else than a belief in a single delusion ;
but as monomania has become an acknowledged word, and new terms
in science are not often useful, it will be well to retain it, only
assigning to it a wider significance. I only attempt a definition of
monofnania that may accompUsh this purpose, in the hope of eliciting
from some of the many psychological physicians I see around me
some suggestion that may render my definition less imperfect, and
as much as possible in accordance with our individual experience and
observation.

Monomania is a disease of the brain in which deltisionSy or erroneous
impressions J mth morbid states of feeling, exist on one or more subjects,
while on others the intellectual powers remain apparently uninjured.
—It will be objected to this definition that it requires disease of
brain to be admitted ; delusions or erroneous impressions may arise
from other causes, and therefore declaring monomania to be disease
of brain, and disease of brain, monomania, is arguing in a circle. I
have considered this objection, and demur to its validity. It is
true that a delusion may arise, or an erroneous conviction be per-
sisted in, while the brain is healthy. In such a state were the
people of whom the apostle spoke as being under '' delusion/' they
"believed a lie;^' such is the state of the believers in the ghostly
power of HumC; and in the supernatural wonders of the Davenport

1867.] Criminal law ; hy De. Hakeington Tukb. 809

brothers. But in the monomaniac there must be disease^ and that
disease will be indicated by the very nature of the delusions, or
by the general medical history of the case. The want of attention
to the possible existence of erroneous belief, or even of absurd fan-
cies, with perfect sanity, led to the mistake of the two physicians who
declared, or who are said to have declared, their belief m the insanity
of Luther : it was a mistake excusable enough when speaking tinder
the pressure of severe cross-examination ; but how great a mistake
it is, and how unsconsciously it may be committed, was curiously
illustrated by a well-known professional writer in the 'Pall Mall
Gazette,' who, coming to the ^'rescue,'' as he calls it, of Luther, in
effect admits that he should have thought that '^ distinguished ec-
clesiastic,'' as he oddly styles him, to have been insane, if he had
still persisted in his asserting that he had seen the devil after the
writer had examined him, and had by argument shown the folly of
his belief ! ! The story itself is apocryphal : but, assuming that Luther
said, and persisted in saying and thinking, that he had seen the
devU, it by no means certainly indicated insanity ; nor would persis-
tence in such belief make any difference : the whole tenour of the
Keformer's life proved his mental soundness; his vision was the
result of an overworked brain, his conviction of its reality was con-
sistent with his deep religious feeling, his ascetic devotion, and with
the superstition of the age. There was as much and no* more in-
sanity in the honest belief of Wesley and his chaplain that the
prayers of the former had instantly calmed the sea, or the fixed
impression of Dr. Samuel Johnson that he heard his mother call
him *' Sam,^' she being then at Lichfield and he in London. But
if we contrast this with the really monomaniacal, we meet at once the
evidence of disease : thus, Swedenborg we might possibly conceive
to have been sane when he fancied he had seen angels and spirits.
We recognise illusion or hallucination, and that they alone do not prove
brain disease ; but we know him to have been mad, when wjb find
him writing and publishing wicked lies about the Society of Friends,
which he gives upon the authority of the said angels, without the
sUghtest consciousness of the incongruity and folly of quoting such
beings as uttering falsehoods and absurd scandals. On this subject^
his reasoning power has left him.

There are some delusions so gross, that they at once indicate
disordered brain ; as when a man states himself to be the right-
ful king of England, or says that his head is only a tin-pot. In
minor delusions the question of disease must be determined by the
physical symptoms, by the general history, or by the change in
the manner and morals of the subject of examination; on this
point two great lawyers are singularly correct and clear. Sir
H. J. Fust, in the case of Mudway t?. Croft, quoted with appro-
bation^ and applied to the case before him; the opinion of Dr. Bay,

SIO On Monomania, and its Relation to the Civil and [Oct^

p. 55 (Shelford), " It is the prolonged departure without an adequate
external cause, from the state of feeling and modes of thinking usual
to the individual when in health, that is the true feature of disorder
of mind/^ Again, Lord Lyndhurst in one of his judgments says, ^' in
monomania, the mind is unsound ; not unsound in one point only,
and sound in all other respects, hut this unsoundness manifests itself
principally with reference to some particular object or persons/'

With these dicta it would seem that monomania being proved in
any case, either by absurd delusion, by physical symptoms, or by a
combination of mental, moral, and affective morbid changes, the deci-
sion as to the incapacity, of monomaniacs to make a valid testamentary
disposition of their property, would be easily arrived at ; but, unfor-
tunately, this is not so ; juries are too apt to think for themselves,
and to despise that which they believe to be the view of a mad-
doctor ; and, for the reasons I have already given, the definitions of
monomania lead to error, inasmuch as they assume sanity upon
points not connected with the delusion. Chief Justice Hall defines
partial insanity as importing that a person is insane on one or more
important points and sane in all other respects ; exactly contra-
dicting Lord Lyndhurst. Therefore, in the civil courts, it is no un-
common thing for hours to be taken up in reading to the jury the
letters of^ an undoubted monomaniac, with the result of convincing
the jury that the writer is perfectly responsible, or has full posses-
sion of his faculties, although any one accustomed to observe mono-
mania would be prepared to find even acuteness of intellect in many
cases of serious brain-disorder in which partial insanity was demon-
strable. It must, of course, be admitted that the border line
between the delusion or erroneous impression of a sane, and those
of an insane brain, is very difiicult to define; but it is obvious
that this difiiculty has arisen, or, at least, been much increased by
the principal test, the presence of disease, being so much ignored; it
is forgotten that monomania is only a symptom, it is not the disease
itself; and just as a fast pulse does not prove fever, so a delusive
impression does not always indicate brain disorder. The question as
to whether a case of admitted eccentricity of thought, or extraor-
dinary actions, or strong and even erroneous religious or hypochon-
driacal impressions, may or may not be one of monomania; that
is, may not constitute a form of brain disorder which renders the
sufferer irresponsible or unable to manage his affairs, seems to me
to be almost entirely a medical question, and in its examination I
would dwell specially upon the following points for consideration in
cases of allegea monomania : —

1st. Are there any morbid or other physical symptoms that may

frimarily or secondarily affect the organ of thought and volition ?
s there strong hereditary tendency to insanity ? Have fits or con-
vulsions appeared, for any of these in addition to a monomania^ even

1867.] Criminal J^aw ; Ay De. Harexngton Tttkb. Bll

of a slight description, would go far to indicate organic brain dis«
ease.

2nd. Is the monomania itself of such a character as to be obr
viouslj a symptom of disordered brain ? or is it associated with ideas
or actions inconsistent with the education, and position, and former
conduct of the monomaniac ?

3rd. Are there any, and what changes in the affective faculties ?
have there been changes in the moral conduct, aversion to those
formerly dearly loved, or irrational behaviour, which, though in
themselves trivial, become important when taken in conjunction with
intellectual aberration ?

4th. Is the will that has been made unjust? or the trust deeds
executed absurd? or the recent marriage ridiculous? or the libel
cruelly promulgated, unprovoked, or unaccountablQ ? The ^^ fac-
tum'' as the la^JTcrs call the provisions of a will, in itself is often
the strongest indication of insanity. And here let me observe that,
often as I have heard the juiy in such cases charged by the judge to
consider the necessity of upholding the will of a deceased testator
as a solemn document, which they should respect, as they would
wish their own wills righteously carried out, I have frequently
hstened in vain for the admonition that apparent justice to the dead
may be the greatest injustice to them and to the living also. Which
of us would not wish, should an inexplicable monomania attack him,
and at his death his will should leave his property to keep cats, and
his intestines to be made into fiddle-strings, that the condition of
his mind should be medically investigated, and those nearest and
dearest to him not left to the tender mercies of juris-consults who
know nothing of mental or physical disease, and who, in deciding
the validity of his will, would seriously consider whether such mono-
mania was or was not consistent with a disposing power.

Of course, in thus arrogating for the profession of medicine so
great a responsibility, I am aware that there is much to be done
before medicine can take the place it ought to hold in our law courts.
It is not now the time to discuss medical evidence; I would only
suggest the paramount importance of educating medical men to
some knowledge of mental disorders, and training all to the habit
of careful and logical reasoning. Our procedure, also, as to consulta-
tions before giving evidence, and the advisability of having one expert
always appointed by the court, are subjects of grave importance in
the consideration of this question.

If, however, the procedure in the civil courts is sometimes contrary
to recognised scientific truths, the criminal courts show a still more
lamentable variance in their decisions. The introduction of the ques-
tion as to the existence of a '^disposing power" in monomania, is
a trivial mistake to that which condemns the monomaniac to the
scaffold, upon the hypothesis that though insane he knows right from.

S12 On Monomania, and its Relation to the CivU and [Oct.j

wrong. The coarse of the legal proceedings in cases of insanity
in which homicide has been committed seems to depend very much
upon the individual judge^ and not upon any fixed law. I am aware
that this is a strong assertion^ but let me illustrate the proposition^
and judge yourselves of its truth. One judge is reported as sa}dng:
'' Is there any necessity, Mr. Attorney-General, after this (medical)
evidence, to carry the case further ;" and the prisoner is acquitted.
Another judge said recently, " I don't consider the prisoner in a state
to plead,^' and at once took the jury^s opinion as to whether the
culprit was insane or not. A third judge, in my hearing, informed
the counsel, who was about to open a defence upon the ground of
insanity, that the question he (the judge) should put to the jury, and
to which he advised the counsel to speak, was not the insanity of the
prisoner, but his knowledge of the difference between right and
wrong : and that this issue only should be put to the jury.

I have never heard a counsel bold enough to venture upon the
doctrine of the possibility of a disorder of volition, although it is known
so well to us all that intellectual disturbance is so frequently accom-
panied by deranged impulses and uncontrollable propensities. But
this is a negative fault in the law ; there is another and more extra-
ordinary proceeding of frequent occurrence. One judge, having
almost compelled a jury to find a verdict of guilty, will, upon
his own belief that there is some lurking delusion in the prisoner's
mind, write privately to request a further inquiry, or ask for a
remission of nis sentence ; while another judge, rigid in his own
view of the law, will allow a monomaniac to be hanged, in spite
of earnest and repeated representation of the uselessness and cruelty
of the proceeding. In such cases the prisoner is not tried by a
jury, but by the judge, is not condemned by the law but by the
Home Secretary. One remedy seems to be patent for these cases —
abolish altogether the punishment of death. The inconsistency
of the legal course is rendered obvious in another way. Homicides
already certified lunatics are always removed from the asylum to prison
to await their trial; and yet we hear that, at the last assizes at York,
a prisoner having become insane, has been removed from prison to
an asylum, and therefore cannot appear ! I will not dwell upon
the error, and sometimes cruelty, of trying and condemning to
death or lifelong imprisonment the unfortunate victims of puerperal
monomania who have killed their children. It may be state policy
— it may, indeed, be necessary — that infanticide should be severely
dealt with ; nevertheless, it is our duty to say boldly that law in
these cases may not be justice ; the teaching of medical science and
the experience of physicians should be called in to avert the punish-
ment of a crime so frequently the result of physical disease.

With regard to minor offences, the law is again in a most unsatis-
factory condition. There seems to be no fixed rule to guide judgei^

1867.] Criminal Law; by Dr. Haehington Tukb. 813

or magistrates. In one case, a man charged with assault, and whom
I examined at Pentonville Prison, was not brought to trial because
insane ; again, an insane gentleman, whom I found undergoing im-
prisonment in a county jail, and very resignedly picking oakum, had
already been brought to trial and condemned ; and in a third case, one
of forgery, by a man whom I had stated to be suffering under brain
disease, the judge, to my astonishment, in his charge to the jury,
informed them that if they believed me the gentleman would be
confined, perhaps for life, as a criminal lunatic, whereas, if found
guilty, he would have only a short imprisonment. I may as well
mention that the jury, in this case, solved the legal difficulty by
finding the prisoner ^^ not guilty,^^ and, acting on the judge's hint,
said nothing as to his insanity.

In defining monomania then as essentially a disease of brain, it
would seem to result that all wills made by monomaniacs must be
considered invalid ; and that for all acts done by them they must be
irresponsible. My argument would hardly go so far. It is by no
means necessary that all sufferers from chronic or acute brain dis-
ease must necessarily die intestate ; let the validity of the wills in ques-
tion be tried before a jury, and if found reasonable, let presumption of
a lucid interval be fairly laid before a jury or a competent arbitrator.
The provisions of the will would afford the strongest evidence of the
capacity of the testator. I take it, that alienation of property from
relatives, that sudden and causeless testamentary changes, that
codicils hurriedly added, would hardly be admitted as valid where
medical evidence strongly proved the testator's brain to have been
diseased. Opposition to a perfectly fair and rational will would
be tmdertaken at the peril of the opposer, who would, however,
have an easy task where the medical evidence was strong and the
will itself strange, capricious, and unfair.

The admission of the possibility of a monomaniac making a will
that may consistently with justice be considered valid may seem to
involve the admission of the criminal responsibility of those suffering
under brain disorder, and to a certain extent it clearly does do so ;
I can see no reason why the monomaniac who is so far well as to be
able to enjoy his freedom and exercise his civil rights should not be
responsible for minor offences unconnected with his special delu-
sions, otherwise all monomaniacs should be confined, which would
be cruel and indeed impossible.

. I would punish the monomaniac not to revenge any wrong he
may have done society, but to prevent other monomaniacs from
imitating, or himself from repeating, his offence. Carefully exa-
mining the objects and mode of proceeding of the criminal, it would
rarely happen that any injustice could be done. The semi-insane,
if allowea to be at large, must feel the necessity of self control, and
they oftea can and do exercise it; it is a false philanthropy that

314 TAe Insane Poor in Middlesex , and the Asylums at [Oct;,

would excuse all monomaniacs from punishment^ because such im-
punity must involve a punishment still more severe ; for if mono-
maniacs are to be irresponsible they must all be confined or re-
strained.

To sentence a monomaniac to minor punishments seems to me to
be possibly justifiable upon grounds of public policy, but to hang a
lunatic involves, in my opinion, the commission of an absolute crime,
and nothing I have said as to his responsibility for minor crimes
can excuse such a sentence, supposing that the convict is of unsound
mind. For not any man can swear that at the moment of the act
the prisoner knew right from wrong, nor can any jury decide that his
crime was unconnected with his lunatic impression. The disease of
brain must lead to doubt, and of that doubt by English law and by
common justice the prisoner should have the benefit.

I have to apologise to you, sir, and to the members of the
Association for taking them over ground that must be so familiar to
them; but I have tried to show that lawyers diflfer as muq^ or more
than doctors : thus the law is as uncertain as medicine is thought to
be. The remedy for all this is careful, deliberate, and public dis-
cussion of disputed points ; and I believe that our Association can
be made instrumental in rendering essential service to medicine and
the law, if the collective opinion of its members upon such questions
as those I have brought before them to-day could be elicited and
recorded ; carrying, as it would, the weight of the practical experience
and long study of so many men of high reputation in the special
branch of medicine to which they have devoted their atttention.

On tie Insane Poor in Middlesex, and the Asylums at Hanwell and
Colney Hatch, by James G. Davey, M.D. St. And., M.B,.C.P.L.,
late Medical Superintendent of the Middlesex Lunatic Asylums
at Hanwell and at Colney Hatch, &c.

{Read at the Annual Meeting of the Medico-Psychologieal Ameiation, held at
the Royal College of Physicians, July 31*/, 1867.)

Those of us who have kept our attentions directed to the insane
poor of Middlesex— to say nothing of outside counties — must have
been struck with their largely increased and increasing numbers' yeay
by year. Whilst it is a high source of satisfaction to us to know

HanweU and Cohey Hatch; hy Dr. James G. Davey. 815

that there are diseases, neither few nor far between, which it is in
our power to very materially modify and diminish, if not entirely to
eradicate — whilst, in other words, typhus and cholera and other bodily
ailments succumb, in so material degree, to light, air, and water — it
must be and is with deep regret we are compelled to confess our
inability to contend, with anything like a parallel success, against the
dominant and proximate causes so painfully rife among us throughout
the length and breadth of this land, and within the small area of the
county of Middlesex more especially, of the mind's disorders and
irregularities of action. The art and science of hygiene embraces, it
may be said (to speak critically), but the outside conditions, the
accessory or predisposing phenomena, which lead to insanity ; it takes
cognisance of the distal links in the chain rather than of those
proximal — of the remote and not the near or immediate cause
of madness. In what, then, it may be asked, does this proximate
or immediate source or starting-point of this dire malady, as it
exists among the unfortunate classes alluded to, consist? The
reply is a brief one ; a single word can embrace it in all its entirety,
and that word is — '' Poverty.^' Poverty, of which it has been truly
said '^ it eclipses the brightest virtues, and is the very sepulchre of
brave designs/' It is, indeed, the boast of modem medicine to pre-
vent disease — to strangle it at the birth. It is our pride to develop
that condition of things in the physical world with which preventible
disease is incompatible ; but how and where shall we find the clue to
the removal of poverty ? Is there no hope ? Can it be said that
poverty is a normal state of things ? Is it not true, rather, that it is
the mere product of a civilisation only spurious and unreal — of a
Christianity only theoretical ? I am disposed to believe this, and
hence it is I am sanguine that the beneficent results of a reformed
and progressive legislation, dictated by the really good and truly
wise among men, will, ere very long, so greatly diminish poverty that
insanity will decline to no small extent among us. But pending such
a state of things, and accepting the fact as it stands, let us see if we
cannot lessen somewhat the evfl complained of, i. e. attack the effects
of poverty, or, what is the same thing, reduce more or less the great
numbers of insane poor in Middlesex, for whom to this time there
has never been, and is not now, the necessary asylum accommodation.

Now, the increased and increasing numbers of insane poor in the
county of Middlesex is a fact of the first importance to my argument,
a necessary condition or preface of and to that suggestion with
which this paper concludes. The said increase is really my starting-
point, the basis on which all I have to say rests.

The fact, then, a» stated, is very easily demonstrated. Thus, at page
88 of the last report of the County Lunatic Asylum at Colney Hatch,
I gather that in 1851 there were "of lunatics and idiots chargeable
to the county^ viz. Middlesex^ and to parbhes and unions in the

816 TAe Insane Poor in Middlesex, and tie Asylums at [Oct.^

county/' 2465 ; that in 1855 these lunatics and idiots had increased
to 3350 ; that m 1860 they numbered 4048; in 1865, 4650; and
that last year, viz. 1866, they, i. e. the insane poor in Middlesex,
reached so high as 5320. The annexed tabular form presents at
one view the foregoing facts.

A.D. 1851. No. of Lunatics and Idiots 2465

„ 1855. „ „ 3350

„ 1860. „ „ 4048

„ 1865. „ „ 4950

„ 1866. „ „ 5320

The above figures demonstrate an average increase of 190 persons
yearly; a circumstance which carries with it the idea of a future
nothing less than alarming.

By reference to the twenty-second, i. e. the last, report of the
Committee of Visitors of the County Lunatic Asylum at Hanwell,
and to page 111 thereof, we learn that, of these 5320 insane poor in
Middlesex, so many as 1349 are, or were in January of the present
year, " in workhotise^' or ^' with friends ;^^ or, to put it more accu-
rately, the metropolitan workhouses contain 1251 '' lunatics and
idiots 1^ whilst 98 of the J 349 patients are now under the care of
'' friends.'' It may be well to mention that the numbers here given
on the authority of the Committees of Visitors of the County
Asylums at Hanwell and Colney Hatch do not agree with those to be
found in the last (i. e, 21st) report ''of the Commissioners in Lunacy
to the Lord Chancellor." Thus, at page 245 (Appendix K) it is
represented that there were on January 1, 1867, 1470 lunatics and
idiots "in workhouses in Middlesex ;^^ but this discrepancy is of small
moment, inasmuch as it affects not the groundwork or basis of my
argument to be explained hereafter. Now, to give due force and
piquancy to my position, I may be allowed to anticipate somewhat.
If, then, we adopt the decimal mode of reckoning, it will follow that
the multiphcation of 190 (the average increase year by year of the
lunatic poor in Middlesex) by ten will give us in 1877 a total of
1900 patients, outside of or over and above the present very
large army of insane paupers at this present time in existence,
and encumbering those establishments which should be set apart
for those simply poor and needy. That is to say, that after
a lapse of ten years, the annual increase of insane poor con-
tinumg as heretofore, there must then be 1900 in addition to
|;he present 1251 or 1470 pauper lunatics in workhouses, to
be accommodated somehow and somewhere. In a letter of mine,
pubhshed in the 'Lancet' in April, 1856, a. letter which em-
bodies the very sum and substance of this present paper, I have
ventured to predict that in twenty-five years from the mite just given,
Qr> what is the same thing, in fourteen years fjrom this time, the

1867.] Hanwell and Cohiey Hatch; hy Dr. James G. Davby. 3l7

*' Middlesex magistrates^^ might expect to be required to find '' addU
tional accommodation for something like 5000 lunatics!' Doubtless
my estimate is a small exaggeration ; nevertheless it is seen that from
the beginning of 1856 to January of this year the numbers of insane
poor in the county (Middlesex) have gone up from 3350 to 5320, so
realising an absolute accession, during eleven years, of 1970 persons;
this being equivalent to an increase of so many as 4510 patients
in the quarter of a century. TimCy then, that great corrector of
man's aims and aspirations — ^Time — as Shakespeare has it—

« That please some, try aU; both joy and terror
Of good and bad ; that make, and unfold, error*' —

has proved me, in this particular instance at least, not very far out
in my prophecy. However, the advice first offered in the pages of
the 'Lancet' (April, 1856) was altogether unheeded — if so much as
seen by those in power — and to this time no sufficient action has been
taken in the matter; and hence it is I venture now to repeat a
suggestion, to be named presently, which, if acted on as it deserves,
would, in my humble judgment, go far to limit the farther increase
of insanity among the pauper population.

As a matter of course, we are all agreed on these three points,
viz. —

1st. — ^That the union-house is no fit and proper place for the
lunatic poor ; that is, as a very general rule.

2nd. — ^That asylums like those at Hanwell and at Colney Hatch
are not adapted by their magnitude and arrangements to the cure of
mental disease.

3rd. — ^That the asylums named should be regarded as places for
the mere protection and care, day by day, of those irremediably mad.

Under these circumstances, then, what remains to be done ? Are
there no means within the reach of those with power to act and
interested in the cause of the insane poor of Middlesex, whereby a
largely extended and much improved means of accommodation and
treatment may be secured to those so deeply afflicted ? It is with
much satisfaction I refer you to the last report of the Commissioners
in Lunacy for a very practical response to the question submitted
to you. At pages 71 et seq. we find suggestions for the erection
of buildings '^ of a simple style, intermediate in character between the
workhouse and the asylum, and consisting chiefiy of cheerful,
spacious, and well- ventilated day-rooms and dormitories.^' For such
buildings, or '' district asylums'' (so called by the Commissioners in
Lunacy) all due provision is, we learn, made '' in the new Metro-
politan Poor Act for 1867 /' and to these it is proposed to remove
from the two large asylums at Hanwell and Colney Hatch, as well
as from the metropolitan workhouses, so large a proportion of the

318 Tie Imane Poor in Middlesex, 8fe. [Oct.^

incurable and chronic cases of lonacy — the accomnlations of long
years — that the necessary accommodation may be found in the
former, i. e, the asylums named^ for the recent and curable, and in
the latter^ i. e, the workhouses^ for that '^ class of patients among the
idiotic and weak. minded^ whose quiet habits and tractable disposi-
tions not only permit of their living in all respects with the.
ordinary paupers of workhouses, but even render them very often
the most trustworthy and useful of all the inmates in employment
about the houses." It is, I feel, very unlikely for us to withhold
our approval from or of the foregoing recommendations, so far
as they go. But, to my mind, thev lack the necessary completeness.
I would submit for the careful consideration of the Medico-
Psychological Society that it is before all things desirable to erect
in the neighbourhood of London — ^what there is not now — an hos-
pital for the insane poor ; one of the most approved construction,
and embracing both in itself and in the general and medical staf^
attached thereunto each one and all of those means and appliances
held essential, either directly or remotely, io the relief and cure of
the disordered mind. This hospital must on no account contain
more than 250 beds ; otherwise it can be no hospital, but simply an
asylum. Such an institution as that proposed will be, it is evident
to vou, altogether unlike either the asylum at Hanwell or that at
Comey Hatch.

When, in 1851, 1 brought before the Committee of Visitors of
the Colney Hatch Asjrlum the foregoing views in regard to the
increasing numbers of msane poor, and when also I predicted that,
regard being had to such " increasing numbers,'^ the great palace-
like erection at Colney Hatch, with its 1300 beds, including its sister
establishment at Hanwell, "would not long continue to accom-
modate the pauper lunatics in Middlesex^^ (to quote again from my
letter in the 'Lancet' for April, 1856), I was answered by an
incredulous laugh ; but on ray adding to such " views'' and to such
a prophecy, my decided belief that no time should be then lost in
providing a small hospital for the cure of the pauper lunatic, and on
the ground that an asylum so large as Colney Hatch is " too cum-
brous, too much like the common union-houses, to embrace the
many details necessary to the cure of the disordered mind" — ^that
"neither its form of government, nor its internal arrangements,
nor its social and domestic economy, were adapted to anything
more than the common care and safe custody of its inmates " — ^the
patience of the same committee became utterly exhausted, and I
was made to feel that I had, to some extent, exceeded my duty as a
medical superintendent.

Now that the experience of many additional years has furnished
proof both of the increased and increasing numbers of insane poor,
as well as of the many and great advantages of the small *' hospital

1867.] Gmparatm Examination of the Lawi of Lunacy ^ Ifo. 31^

for the insan^' over the large establishments at Hanwell and Colney
Hatch^ it follows, necessarily, that such an hospital as that here
advised is of the first importance, if we would make the most of the
resources of the art and science of medicine, and thereby diminish the

E resent rapidly increasing army of insane among our poorer brethren
ving in this metropolitan county.

It remains for me to impress on the minds of those who hear me that
among the " advantages'^ just alluded to is one of a very especial
character and of large significance, viz. the higher per-centage of
recoveries which obtain at such small hospitals for the insane, to say
nothing of the lower average of deaths. This first must be held to
be conclusive; it furnishes the cUmax to the argument above set
forth.

One word more ; let me entreat you to give to this short paper
your patient attention ; permit me to solicit your calm yet earnest
consideration of the several points herein touched on, bearing well
in mind, not only the general importance of the subject, but its
especial application to the present very pressing question, viz. What
remains to oe done for the due care and accommodation of the present
very great and rapidly increasing numbers of lunatic poor in
Middlesex P

A Comparative Examination of the Laws of Lunacy in Europe,
By Baron J. Mundy, M.D., StafF-Surgeon-Major in the Army
of His Imperial Majesty the Emperor of Austria; Membre
Associe Stranger de la Society Medico-psychologique de
Paris, &c.

{JSMd at the Annual Meeting of the Medico-Tst/chological Association, held at
the Royal College of Phgsicians, July 31^^, 1867.)

Mfi. Pebsident and Gentlemen — Allow me before I go into my
subject to thank you for the kindness you have displayed to me in
electing me a honorary member of your Association, and much more
so as it is perhaps to-day for the last time that I shall have the
honour to address you before my retirement from this branch of

science.

In regard to the subject which I lay before you to-day certainly
the time will not suffice to explain you so large and important a
question, and even if our meeting extended over two or three days.

320 A ComparaUve Examination of tike Law9 of Lunacy [Oct.;

it would certainly not be enough for the complete discussion of a
subject of this extent.

In regard to the laws of lunacy in Europe I begin first of all with
your own land, England ; and it is quite unnecessary for me to say
that I do not intend to criticise the law in England, as you know it
much better than I do. Whatever may be its d^ects^ and it has
some defects, the English law is the best law of lunacy which exists
in Europe. The reasons for which I call it the best law are,
because it is the law which gives the best control of all other
laws in other countries in Europe; and because it is the only
code of laws which has advanced in accordance with the progress
of science. The greater part of the law of lunacy in Europe
has existed from 1801. Certainly I must ask you if science
and if the principles of science on which every law must be based
have not advanced since the year 1801, a period of sixty-seven
years; and if you go in your own subject, if you go only into
work which was done after this time in England, the answer for
me would be quite useless. Certainly science has advanced, and
by advancing science the laws and the principle of laws must be
changed.

I will here make one or two criticisms upon the English law.
Eirst, with regard to certificates, with regard to administration,
subjects which have been referred to to-day by our President and
by Mr. Blake. And then I may mention the very defective part of
your law whereby the magistrates interfere with the medical certifi-
cates in the cases of lunatics who are called before them from work-
houses to be sent to asylums, matters referred to a few days ago in
your medical and other p^ers. And finally, there is the subjwt so
often mentioned by Dr. Tuke, the criminal part of your law, the
distinction which is still now a rule and which certainly cannot be a
good, healthy, or sound one.

These are a few criticisms, and certainly in going into the subject
I could say something more on it, but, as I have so much good to
say of your law in comparison with the other laws of Europe, I will
proceed to discuss the laws of other countries in Europe.

Only six countries in Europe have really what you call a lunacy
act, or a law in lunacy. These countries are France, Switzerland —
some cantons of it, — ^Norway, Sweden, Belgium, and Holland. The
remainder of Europe possesses no lunacy law, but only some dis-
persed rules or ordinances, which began in 1 801, going on till now,
contradicting themselves, repeating themselves, and not making any
real progress. Even Prussia, which has made so much advance in
many tlungs, scientific and others, has made very little change in the
ordinances with regard to lunacy during the last twenty-five years.
So with Austria, Italy, and Spain, all countries having no lunacy
law at aU.

1867.] ifi Europe; h/ De. BaAon J. Mundy. 321

Going back to those countries which possess lunacy laws, I will
first glance at the French law. I would first remark that it id
inferior to your law in those points in which your laws are
superior to many others. First of all, the control exercised is very
weak. It will be sufficient to recall to your memory that the certi-
ficate of one medical man is quite enough to shut up any man
throughout Prance without any control. Fifteen days after he is
shut up an inquiry goes on, and the certificate is signed by the same
medical man who signed the first certificate. There are no Parlia-
mentary reports on the question, and all the reports made by the
commissioner are secret and never pubHshed. Then ^there is a
rule in the law of 1838, which constitutes the Prench law, which
says that for reasons which they do not call political reasons, but
which they call disciplinary reasons, for a certain time the chief of the
department, as they call it, can even shut up a man without any
certificate as a lunatic. There is quite an absence of what you call
de lunatico inquirendo. In Prance the law says clearly that if a
man is not capable of taking care of himself and of his affairs he ii^
interdicted ; and interdiction is effected without the certificate of a
medical man, being done at the will of the magistrate. And as the
magistrates have no high standing in psychology you may imagine
that such interdictions are sometimes very unjust, and bring ruin,
not only on the individual, but also on the family. On the other
hand, il the magistrate refuses to interdict where an interdiction
ought to be granted, equally serious consequences arise.

There is no control, as I have said, even in regard to that most
important point of restraint. As I have often said to you, and will
repeat again, in Prance about 2000 of the insane are constantly
in strait-jackets. But although some publications of very high
importance speak about all these defects, still the medical men
engaged in our line of science contend that the law of 1838 in
Prance is a very good one and wants no change. I do not share in
that belief, as I have contrasted your law with the French law ; and
you may judge from the few words I have said whether that belief is
warranted or not. Certainly the liberty in France of speaking and

S'ving opinions about the thing is not such as in England, and the
edico-Psychological Society in France has ijo right even to discuss
the law ; even to propose an amendment scientifically is a very dan-
gerous experiment, and if they went into such dehcate subjects the
existence of the society itself would be rather doubtful.

If we turn to Belgium and other countries we shall see that their
laws are really nothing but a transcription of the law of 1838.
Those cantons of Switzerland which have a settled code adopt the
same law, whilst the other cantons have no lunacy law, but simply
ordinances.

Sonde important amendments, however, have been made in BeU
giam« Parliamentary reports are prescribed hj t\xQ ^ixisfi&^^'&sss?^,

S22 A Comparative Etammatian of tie LatM of Lunacy [Oct.,

which are sunilar to yonr reports^ although they do not go into
detaU like yours^ and are not published annually^ but every second
and third year. In Switzerland there are no reports. And in
Belgium^ instead of Commissioners in Lunacy who are medical men,
there is generally what they call the Procureur du £oi, a man who
is the chief of the justice department, who inspects the asylums, and
to whom every complaint is to be addressed. He is no medical man, of
course, and understands very little of lunacy ; and so there are frequent
collisions between him and the medical man, and many mistakes arise.

Coming to Holland, I must confess that the law in Holland
originated from a great man, Schroeder van der Kolk, and a va:^ im-
portant part of the law in Holland is that which regards, and justly
so, the medical profession. The reports of Holland which Schroeder
van der Kolk organised are very good indeed. I may state as an
instance that the so-called therapeutic part of the report transcribes
even the effect of anv medicine given to the patients, the influence
of freedom and family life, and the influence of restraint ; and every-
thing is so nicely put and prescribed that the reports are really very
instructive. It is Schroeder van der Kolk, a great physiologist, to
whom belongs also the merit of having abolished entirely by a good
public asylum the private asylums in Holland. It is the only
country in which no private asylum is in existence.

Norway and Sweden organised their lunacy law, the one in 1838,
and the other in 1845. Sweden was some few years the later of the
two, taking the law from Norway. It is very curious to see that m
the countries where the proportion of the insane is so very high as
it is in Sweden and Norway (for these countries have the highest
proportion of the insane in Europe), the laws came in the one ten
years only after the other. The prescriptions are generally the same
as in the. French law, with a few alterations of no importance.

That is the historical account of the lunacy laws of Europe, how
they came and how they have been instituted.

Coming now to the countries where no law is in existence, I will
quote a few instances to show how defective they are in their
totality. Take an instance from Austria, where there existed till
lately a law whereby the medical superintendent had power and
authority to punish the insane; a disciplinary right was given to the
superintendent to punish an insane man ! Such regulations in
existence in our time remind us of the time when at Bedlam the
insane could have been seen by paying a peiiny. But this time has
gone, I believe. Another ordinance in the Austrian law authorised
the chief of a town, who is the chief of the police, to send anybody to
an asylum without any certificate — ^in my opinion a very dangerous
rule, as everybody who was not on good terms with the chief of the
police could be sent there, no certificate of a medical man engaged
in lunacy being needed. .

. 'But the worst. p;ui) of .all these, laws^ including, the; countries

1867.] m Europe; by Dk. Babon J. Mtjndt* 823

which have laws, is that they have no right definition about
insanity. The definitions of insanity, so very importatnt in
legal cases, are still the same as they were at the time of
Esquirol, ConoUy, and others. There is no good and clear defini-
tion about idiocy, there is no good and clear definition about
insanity — definitions which alwavs are wanted in legal and even in
civil cases, and which never can be given clearly. But not only are
these definitions wanting, but, as science has made in the last twenty
years great progress, you must ask yourselves if no new definitions
are wanted, if no new characters of disease have come out which
may be very important in the administration of the civil law, and
much more so in criminal cases. For instance, there is aphasia,
never known before, a disease which is now so important in medical
legal cases — aphasia, not being able to speak. Constitutional
syphilis has quite, I may say, overgrown many diseases which were
prevalent before this disease was known as a very important disease
of the brain. Then there is Morel, who has distinguished himself
80 much in new inquiries as to the instinctive diseases, what the
French call manie instinctive ; and as the gentleman may be here

E resent, I may quote himself, we have Dr.Westphal, from Berlin, who
as been makuig such great inquiries about the laws of paralysis,
and who has changed entirely the old laws of paralytic diseases by
pathological inquiries — ^by inquiries that can be and have been
demonstrated ; the efiTect of which are so important upon insanity that
medico-legal cases have quite another face before the judge and
jury, if they are explained on the basis of the new science. Even
idiocy, cretinism, and so many symptoms of mania once before by
routine called simple mania, or making a certain degree of mania,
which are not in existence at all, but which are nothing else but
variations of a disease which can be to-day a mania and to-morrow
a melancholia — these things now want to be taken together, and
out of them to be constituted a new law in lunacy, a new law based
on the definition of the new diseases.

After this diversion, to quote you some instance from another
land, I may refer to Prussia, where only twenty years ago there was
a provision that a man who committed a murder should not be
hanged if it was proved that he committed the murder to be hanged.
This law was only aboUshed twenty years ago. Then with regard to
pyromania, a circular was sent out to the judges in Prussia warning
them against committing men for trial affected with this disease.
Hiis was in vogue for five and twenty years, and then a circular
came out warning the judges to take no care about such a disease,
which certainly was not in existence, and to commit everybody to
prison who feigned pyromania. Time is not sufficient to mention
other very striking instances, and I may say that in Italy the law is
as bad as i^ Austria, as bad as in S^ain and in Aussia, where
.:f»rt«lly.^^.tbe..QM8yrteaip/Bedlftn\i^^

824 Cimparaih& BapatmmUion of the iaws qf£wkiey, §^. {Octj

I will now make a very few remarks in r^ard to the laws for th^
future.

And first I repeat that a new law must be based upon new prin-
ciples of science^ for without that the new law will not be of the
slightest use. The want of books is a very important defect^ and I
am very much pleased that the man who devoted his life to this
important branch of study has written a very useful handbook with
regard to mental diseases in legal cases — ^I refer to our honoured
firiend Dr. Bucknill. I may say that^ excepting the little handbook
of Dr. Bucknill's^ there was not a single book written on this branch
of science and jurisprudence. The books in existence mix up all
the legal cases and all the medico-legal science ; Dr. Bucknill has^
however^ written a small essay and has promised to give us a
more extended work, which we shall be very glad to see. Morel
certainly began a similar book, but I am sorry to say that, except
the first portion, the book has not appeared, which is to be
regretted, as Morel is a very able man. If ow, as I said, the new
principles of law must be based on the new progress in science ; and
as there is so much need for books on the subject, I may propose
that prizes for such books should be offered by wealthy men or by
societies. If your Society was a rich one, certainly you would con-
sent to give £1000, if anybody would write such a handbook
embodying the principles of the science, as it stands now in
1867.

Secondly, I touch on a very dehcate subject, on which the Presi-
dent has spoken to-day, and it is a course of procedure which in
my opinion must be certainly changed — I refer to indiscriminate
sequestration. Our President has, in his address, protested against
indiscriminate sequestration, but I am sorry to have to say that in
Europe, out of a number of 600,000 insane, more than 350,000 are
sequestrated. I think that shows that there still remains indiscrimi-
nate sequestration, not only acknowledged as a necessity, but even
sanctioned by the laws of every country in Europe. It is greatly to
be desired that the practice of non-restraint should be adopted on the
Continent. It is quite a matter of shame to have to confess that
50,000 insane people are shut up in cells, and in very gloomy ones,
and put in strait-jackets. I think a sound and energetic protest on

Jour part would do much to remedy this barbarous state of things,
f you do not protest against it it will not be altered. The subject
of control is a very important one, not only the control of the
medical man, but also the control of the patients. I am sorry to
have to state that, with the exception of England, the social position
of the physician in Europe engaged in lunacy is a very poor one,
and needs great improvements.

Rnally, I may say, if a new law in lunacy is really proposed for

' sa manv countries that do not possess it, it would be necessary to

make those new laws unifotm% It is a pity that the auUiority with

^1867.] On the Bxteh^loti of the Organism in three Dimensions. 325

regard td lunacy should, in different countries, be placed in so many
different hands. In England the Lord Chancellor is the man who
has all lunacy matters under his care. In another it is the Minister
of the Interior, the Home Office in another. Sometimes the Minister
of Commerce is the man who is to take care of the interests of the
insane. There a real rational basis is also wanting.

I may be asked, ''Who is the man who should propose and
execute all these things ?'' I must reply freely and openly that I
believe it is the medical profession themselves who should propose
such things. If we are always silent, leaving things to go just as
they are, fearing to he censured, we shall never make progress, and
the governments will be very satisfied with our labours so far as
they are not burdened. But, in my opinion, it is the sacred duty of
every member of our profession to do his best to propagate sound
and new principles, to urge those who have influence in such matters
to make further progress, to make official propositions, and so by-
and-by to come to a real and to a good law in lunacy, which, though
it is the best in England, is even there defective, whilst in the
other countries of Europe it needs a radical reform.

How the Extension of the Organism in three Dimensions is realised.
By the Eev. W. G. Davies, B.D., Chaplain to the Asylum,
Abergavenny.

The subjective character of sense-consciousness. — To the physio-
logist of the present day it must be clearly manifest that, in respect
to what is revealed to us by the senses, we have no immediate
knowledge of anything but sensation. Even according to Sir
WUlam Hamilton, perception proper takes note of nothing but the
sentient organism. "All perception is a sensitive cognition; it
therefore apprehends the existence of no object out of its organism,
or not in immediate correlation to its organism, for thus only can
an object exist now and here to sense.^'^ An effect is produced
upon the peripheral extremity of a nerve of sense; this is conveyed
to the appropriate centre, and there calls forth a sensation.

In the first place, then, the only immediate object external to them-
selves which tne intellectual organs can have to stimulate them into
action is a sensation, there being no way discoverable in which a per-
ceptive faculty can come, without the intervention of a sensation, face
to face with any portion of the organism, much less with any external
body. A man's members are existent to him only in so far as he
is seiiitient of them ; his only organism is his sentient organism, his

• ' Hamilton'B Beid,' p. 879, par. X85

• • - *

826 On tie Erienmn' of the Organim in {tree ' [Oct.,

only world his sentient world. The existence of a world other
than the sentient may be thought possible, but it cannot exist for
us ; and some are to be found who, indeed/ question its existence
altogether, because internal causes are known to rouse sensations
which appear to be extra- organic. Thus^ congestion in the capillary
vessels of the optic nerve, or a chemical agent exdting the nerve
through the medium of the blood, causes visual sensations in the
entire absence' of their natural stimuli. Such disturbances^ under
the name of hallucinations, are quite familiar to the physiological
psychologist, as affecting all the senses. Hallucinations sometimes
exist indeed without involving insanity. *'Thus, Andral, on entering
his room, distinctlv saw for a quarter of an hour the corpse of a
child which he had dissected a short time before. Johnson, one day
at Oxford, when he was turning the key of his chamber, heard his
mother distinctly call ' Sam,' although she was then at Lichfield.
Jerome Cardan, the physician, and Erhard, both beheved that they
were attended by a supernatural personage. Erhard's companion
was always attired in a black cape. Napoleon was said to have in-
terviews with a familiar spirit in the form of a little red man ; and,
on better authority, we are informed that he saw his star. ' I see it,'
said he, ' in every great occurrence ] it urges me onward, and is an
unfailing omen of success/ ''*

Some persons, while'admitting that we have no knowledge of the
external world, for our world consists exclusively of our so-called
objective sensations, still maintain that there are, external to us,
certain forces which rouse these sensations in us. But this is not so
evident as not to have given rise to scepticism. Say we have an im-
mediate cognition of an external force m electricity, but this imme«
diate cognition, the idealist may hold, must be a sensation^ and as
such exists in us only. If to account for our sensations we infer
an external stimulus and call it electricity, what is this but hypo-
thesis, or, as Comte would call it, metaphysics ?

In the second place, this view of the matter will be more evident
if we consider that our sensations, whether objective or unemotional,
subjective or pure feeling, are not cognized in the locality in which
they apparently exist, but in the brain or sense-centres. For ex-
ample, when we have, as we say, a pain in the foot, conscious-
ness is not present face to face with the pain in the locality in
which we place the foot, but in the locality in which we place the
brain. It is just the same with our outward sensations. When I
am conscious of this pen as being held in my hand, my various
sensations are not there where they are felt to be, but in their re<«
spective sense-centres. Let us suppose, for the sake of illustration,
that these centres, instead of being but a short distance &om the
locality apparently affected, were a long way off from them ; let us
imagine a giant a mile in length ; now^ a twinge in his big toe would be

• 'Psychological Medicine,' p. 143.

1867.] Dimensions; hy ^^^Bev. W. G. Davies, B7D. 827

a sensation occurring in his brain, although in appearance at so great
a distance from that organ. This shows plainly how impossible it is
for us to be conscious of the organism, much less of the external
world, presentatively or in themselves. We are not in the imme^
diate presence of either of them. In the case of the giant, for in-
stance, a line of nerve a mile long, a sense-centre, and the action of
that centre resulting in a sensation, all intervene between his intellect
and his foot. We are dependent upon the veracity of an inter-
nuncio for the existence both of the body and its environment j
and the grand question which has to be decided is, whether con-
sciousness only possesses that amount of truthfulness accorded to it
by the idealist, or that greater amount accorded to it by the think-
ing many."*^ But how does sensation appear to have its seat out of
the brain ?

Localised sensations. — Some of our sensations are apparently
seated in various parts of the body. That this is the case with
all sensations involving contact with, and resistance from, some-
thing which is felt to be external tiO the organism, none will deny.
What we touch (felt also as touching us), what resists our pressure
(felt also as being resisted by us), is always in some definite
locality of the skin. But even our internal corporeal feehngs are
experienced as relatively out of each other in space. Some, how-
ever, contend that we should have no notion of the locaUty of a
pain, for example, in the foot, were we not conscious of the foot as
a tangible and visible object, and that we are aware of the seat of
the pain because we associate with it our notion of the foot as a
tangible object. But assigning a pain to a certain part which id
known by an outward sense means this — although we had an in-
ternal cognition of the pain, unless we had an external perception of
the foot as well, we should not be able to locate the pain by asso-
ciation in a place of which we know nothing. This is granted.
What is contended for is, that although we could not locate a
pain in the foot unless we were aware of the existence of the latter,
we stUl should be perfectly certain that a pain, as in one foot, was
quite distinct from a pain as in the other foot ; that is, we should
experience them in separate localities. " The opinions so generally
prevalent,'' says Sir William Hamilton, 'Uhat through touch, or
touch and muscular feeling and sight — ^that through these senses ex-
clusively we are percipient of extension, &c., I do not admit. On
the contrary, I hold that all sensations whatsoever of which we are
conscious as one out of another, eo ipso, afford us the condition of

• If this subject were more fuUy entered into, it wojild have to be shown that
onr outward sensations are apprehended as external in space to the whole field of
intetnal leofaldon, that is, to the whole of the organism as the seat of expotion —
pain or pleasure. Moreover, our outward sensations are distinguish.ed from the
other class by t^e entire absence of animate qualities. From these two causes, it
is, they are^eog^iized at noi»self.

828 (hOeEgteBwmofaeOrfmnmmarm " \[Oct,

immfJiatdy and neoesaril j wpfaSaeoHaskg exieiiaoii, for in the om-
fKioumiem ittdl of such reciprocal outness is actiudlj inrolred a
perception of difEerence ot place in spaoe^ and, OMisequaitlT, of the
extended*^'* Mr. Bainf contends against this view ol the snbjecty
and holds that we realise extension by means of the activity of our
locomotive organs* Bat both physiologj and reason are against
b'm* If we are not in some sense oonscions of a limb as extended
and solid, how can we become aware that we move it at all ? In
chronological as in logical order, motion inyolves the existence of
that which moves, bat that which moves may be at rest. What is
contended for, then, is, that a limb at rest is realised as an extended
object by the outness from each other of all the sensitive minima
which are then localised in it, and that the sensations which are felt
and localised when the same limb is pat in motion are an addition
to the former, and presuppose them, i. e. the former sensations are
a condition iine qud non of the latter. Moreover, in order to realise
a sense of motion there most be a comparison of two objects at
least, the one changing its place in relation to the other^ for the
mere movement of a limb would not be realised as motion if there
were not by means of comparison a perception of change of place
in the limb relatively to other parts of the body and to other objects.
Now all this implies that the objects compared must be already known
as occupying space. Were a coast to ^Ude along at the same rate,
and in the same direction as a vessel which sailed along it, we should
not know that either of them were in motion; and in like manner
if, when one limb moved, every other portion of the body and every
surroundinfiT object kept in the same relation of space to it, how
should we know that we moved the limb at all ? The mere act of
the will, followed by muscular effort and its attendant sensations,
we shoald be fully conscioas of, but since we detected no change of
place in relation to other objects we should be at our wit^s end^
and believe that all was a dream. It seems to be manifest^ then,
that Mr. Bain is committing a petUio principiu In order to be
conscious that a limb moves we must be conscious also of that limb
in so far as it is the substratum both of rest and of motion, namely^
conscious of it as possessed of extension.

Why certain ot our sensations should be localised in the body,
•• e. stand out in distinct isolation from each other in space, while
others, such as those of hearing and smell, are not distingmshable
in the same manner, i. e. do not stand out in distinct isolation from
each other in space^ can never, it is presumed, be accounted for;
it is an ultimate fact, and, therefore, inexplicable. We can assign
but onp reason for thought being a function of the vesicular neurine
of the braiuj and for disease in this neurine being attended with
insanity^ namely, that such is the Creator's will; in like manner fc^

« <HamUtQn*b Bdd,' p. 861. note.

t « Tht Stuaai and tbe LiteUfic^' Book II, Cbt^. lii» $ «7»

1867.] . Dimenmm; lyihe Rev. W. G. Davibs, B.D. ." 329

the fact that certain sensations reveal extension, we can offer, appa-
rently, no other explanation. The perfect isolation from periphery
to centre of nerve-filaments and their minuteness, do not account
for their being revealers of extension, but simply afford ocular evi-
dence that each nerve-filament has a separate message to convey to
8 distinct sensitive point. The reason why these points are felt in
space can perhaps never be explained. The phenomenon, to all
appearance, is primary, and, therefore, inexplicable; and, as inex-
plicable, incomprehensible.

How localised sensations are apparently present in a locality
other than that in which they are generated, — How is it that a sensa-
tion which is aroused in the brain is seemingly present in one of the
extremities of the body ? Sir William Hamilton has written some-
thing on this point, which, if not affording a right explanation,
strongly suggests one. " Be it observed, that it makes no essential
difference in this doctrine, whether the mind be supposed proxi-
mately conscious of the reciprocal outness of sensations at the cen-
tral extremity of the nerves, in an extended sensorium commune,
where each distinct nervous filament has its separate locality, or at
the peripheral extremity of the nerves, in the places themselves where
sensations are excited and to which they are referred. From many
pathological phenomena the former alternative might appear the
more probable.* In this view, each several nerve, or rather each
several nervous filament (for every such filament has its peculiar
function, and runs isolated from every other), is to be regarded
merely as one sentient point, which yields one indivisible sensation,
out of and distinct from that of every other, by the side of which
it is arranged ; and not as a sentient line, each point of which,
throughout its course, has for itself a separate local sensibility.
For a stimulus applied to any intermediate part of a nerve is felt
not as there, but as if applied to its peripheral extremity, a feeling
which continues when that extremity itself, nay, when any portion
of the nerve, however great, has been long cut off. Thus it is
that a whole Hne of nerve affords, at all points, only the sensa-
tion of one determinate point. One point, therefore, physiologi-
cally speaking, it is to be considered.^' t All that line of nerve
which stretches between the brain and the foot is in cousciousness
null. A message is conveyed by a nerve from its remote to its cen-
tral extremity, but the nerve being in itself incapable of experiencing
any feeling, none is felt till it has excited the sense-centre, and there
it is that the feeling first manifests itself. Each nervous filament is

* Pathology proves as clearly as physiology, that the brain alone can be the
seat of normal and abnormal mental action ; that the normal state of the mental
process depends nponthe integrity of this organ ; and that both together are
inflnenced by the state of the other organs in disease. — ' Qriesinger on Mental
JDUeates* TrtmslaHon hy Dr. Sobertson and Dr, Mutherford, p. 8.

t ' Hamilton's Beid/ p. 861, note.

880 (h tie Esetmsum of iAe Organism in three Dimensiom. [[Oct^

therefore not only not a sentient lincy it is not even a sentient ^(?m^^
it merely serves to excite such a point in the sense-centre. But
how, in that case, does the feeling seem as if it were in the foot ?
In this way — the sensorium, as such, is not itself localised in con-
sciousness. We do not feel that thought and emotion are in any
place in particular. What an easy task the phrenologist would have
of it if he felt rage kindlii\g above the ears, pride towards the crown
of the head, benevolence in the upper part of the forehead, and the
intellectual faculties working away like busy bees in their narrow
cells below» We should never have had such expressions as " the
thoughts and intents of the heart,'' and "bowels of mercy,'' if
thought and emotion had a clearly defined habitation in conscious-
ness.

In corroboration of the fact here stated, it is found that when any
portion of the brain is laid bare it is not susceptible of the feeling
of touch ; if it were it would be conscious of the place which it
occupies, and thought and emotion could never have been assigned
to so many regions of the body by those who were so very slightly
acquainted with it.* Indeed, if sensation were consciously localised
in the spot in which it comes into being, the problem which it
is now attempted to solve would never have had an existence.
Sensation would be experienced as if it were in the sense-centre,
and a pain, for instance, in such a place as the foot would never
have to be endured, for how could a single feeling appear to be
at one time in two distinct localities ? The sensorium, therefore,
must not be localised in consciousness, else our sensations would
necessarily appear to have their seat in the sensorium, and not, as
now, in various localities of the organism.

Now, in the sense-centres which we are considering each sensi-
tive point is distinctly apprehended as separate in space from every
other, and this not simply in two dimensions, but in three, that
is, in solid or trinal extension. In consequence of the sense-
centres, as such, being in consciousness unlocaHsed, while the
sensitive points are cognised in trinal extension, these poiats are
realised as if they were in various regions of the body, that is, in
short, in the localities in which they are asserted by the many to
be exclusively present.

In order to show how the various localised sensations, objective
or unemotional and subjective or emotional, become associated
together, we cannot do better than consider the curious phenomenon
of a man who has had his leg amputated apparently feeling pain in
the foot which he no longer possesses. This phenomenon is often
cited as proof that pain is seated in the mind. The nerve-fibres
which extend from the brain to the foot are in consciousness void,

* Certain feelingi, cmch as vertigo, headache, sense of tightness, are of conrse
consciously located Ui the head, bnt sensation, thonghti and emotiOD, are not
localised in their respective organs.

1867.] The VehciCy of Nervt'Force. 831

bat they excite in the sense-centre the sensitive points with which
they are severally connected. Now, the shortening of these fibres
does not alter their connection with the brain, consequently the sen-
sitive points are stimulated into action by the shortened nerves in
the same manner as they previously were by the nerves in their full
length. The sensations are therefore alike in both instances. But
then, with these internal sensations, others of an objective character,
namely, those derived from touch proper, the muscular sense, and
sight, have become associated. Thus, with the internal feelings
bdonging to the foot have become linked its solidity, size, figure,
colour, &c., consequently, the former call up thoughts or notions of
the latter. For instance, when a man who has lost his leg feels pain
in the stump, the pain occurs in the self-same points in which it
occurred before the leg was amputated. Stored up in the man's
memory, however, there are certain notions which have become
firmly associated with this sort of pain ; in physiological language,
certain actions of the brain-cells have been in the habit of being set
up whenever such pain is experienced. These have now been ren-
dered faulty and need to be replaced by a new set of actions. The
man must, in fact, learn to connect with certain feelings the notion
of the stump instead of the lost foot.

Our localised sensations, then, have their real seat in the brain ;
they, nevertheless, appear to have their seat in various localities of
the body. This is accotmted for by the fact that they are apprC"
hended in trinal extension, while, as the seat of thought and emotion,
the brain has, in consciousness^ no local habitation.

The Velocity of Nerve-Force.
{Abridged fiom the * Revue des Tkux Mondesi August 1*^, 1867.)

The nerve-current which transmits sensations to the brain, and
the orders of the will to the extremities of the body, requires a cer-
tain time to travel in. Impressions coming from without are not
perceived at the instant they are produced, they travel along the
nerves at the rate of 20 to 30 metres (25 to 40 yards) in a second,
which is the same speed as that of the carrier pigeon, of a hurricane,
or of a locomotive engine at its quickest, but very much less than
that of a cannon ball. Por instance, we can onlv be conscious of
an injury to one of our feet about one twentieth oi a second after it
has actually occurred, and the commands of the will proceed equally
Jowly from the centre to the peripheries of the nervous system. In
he human body the time tbna occupied \% unimportantj but let U9

832 The VeloeUy of Nefve-Foree. [Oct.,

take the case of a whale^ where the telegraphic network of the ner-
vous system is far more extensive. A hoat attacks the whale^ and
a harpoon is driven into its tail. The impression thus produced
has to travel over some forty yards before reaching the head-quarters
of the will; a second is thus lost. How long a time is then re-
quired for reflection? That must depend upon circumstances; but
at any rate it is certain that the will has need of some definite
amount of time for its decision. The order to capsize the boat is
despatched to the taU^ but another second must elapse before the
telegram reaches its destination^ and in the time thus employed the
whaling boat has pulled off and escaped the danger.

Several methods have been devised by physiologists for measuring
the velocity with which nerve-force travels. Thus, a physician of
the middle ages,^ mentioned by Haller, fancied that this might be
calculated by comparing the supposed diameter of the nerve-tubes
with that of the aorta, as he supposed the velocities of the blood
and "animal spirits" to be the inverse ratio of the vessels con-
taining them, from which data he calculated that nervous influence
travels 600 times more quickly than light.

Ualler^s own mode of procedure was scarcely more rational. He
counted the greatest number of letters he could articulate in a given
time, which he found to be 1500 per minute. Now the letter r
requires, according to him, ten successive contractions of the muscle
which makes the tongue vibrate, whence he concluded that this
muscle can contract and relax 15,000 times, that is, can move
80,000 times in one minute. From the brain to the muscle the
distance is one decimetre ; if, therefore, the nerve-force passes over
that space 80,000 times in a minute, it must travel at the rate of
three kilometres per minute, or fifty metres per second. We need
not point out that this process is a mere series of mistakes, but it is
strange that the result should happen to be so near the truth.

No attempt was made until 1850 to study this question in a
satisfactory manner, when one of the most distinguished of modem
observers, M. Helmholtz, undertook its investigation. He at first em-
ployed Pouillet's "chronoscope,^' a machine in which a galvanic
current of very short duration makes a magnetic needle deviate, the
duration of the current being measured by the amount of deviation;
by this means as short a time as some thousandths of a second can
be measured. M. Helmholtz fixes one end of a muscle from the
leg of a frog, and attaches the other to a small lever which forms
part of a galvanic circuit, so that at the moment of contraction the

♦ The mediffival physiciang and the schoolmen held as a conseqnence of
Aristotle's and Galen's theory of '* animal spirits," that time was required for their
passage from one part of the nervous system to another; and it is even curious to
remark how the later schoolmen opposed the Cartesians who thought the con-
trary ;^— an example of the advantages derived by the schoolmen from including
even bad phynology in th^r scheme of philosophy. — J. B. G.

X867.] The VdoeOif ofNerve-Farce. 83$

circuit is broken and the time registered by the chronoscope. The
current is first sent directly through the muscle^ and then through
a given length of nerve which has been left adherent ; the diflFerence
in time between the two cases gives the velocity of the nerve-force,
which by this process is found to be 26 metres (85 feet 7 inches) in
a second.

In a second method, also employed by M. Helmholtz, the lever
raised by the contraction of the muscle has a point which traces a
line upon a sheet of blackened paper, which is kept moving from the
moment of excitation, and the curve produced by the movement of
the lever registers all the phenomena of the muscular contraction.
This apparatus, called the " myograph,'' gives the velocity of nerve-
force as equal to 27 metres (88 feet 10 inches) per second; several
modifications of the instrument by different physiologists have given
very closely agreeing results, and have also shown that the velocity
is diminished by sending an electric current through the nerve, or
by a low temperature.

Experiments with the same object have been made upon man in
the following manner : — An electric current is suddenly applied to
the skin, the moment of application being registered by the turning
cylinder of a chronoscope, and as soon as the person experimented
on perceives the slight prick produced by the current he touches
an electric lever by which a second mark is made upon the cylinder.
The interval between the two, which can be thus measured, is made
up of the following elements, viz. transmission of the impression to
the brain, the mental process there gone through, the transmission
of the voluntary impulse to the fingers, and the consequent muscu-
lar contraction. But if this experiment be performed on two diffe-
rent parts of the body, as, for instance, at the groin and at the great
toe, all the other elements of the delay will remain the same except
the time occupied by the transmission of the impression upwards,
and the velocity of nerve-force in man can be thence calculated.
M. Hirscb, the director of the Neufchfi-tel Observatory, was the first
•person to make these experiments, in 1861, and from them he con-
cluded that nerve-force in man passes over 84 metres (112 feet) in
a second. Dr. Schelske has repeated the same experiments, and
deduces from them a sUghtly less velocity, 29^ metres (97 feet) per
second. By similar means it has been shown that the rate of trans-
mission through the spinal cord is the same as through the nerve
trunks, and that a reflex action requires from one tenth to one
thirtieth of a second more than the mere direct conduction of ex-
citement to the muscles.

> The time required for certain cerebral operations has been

measured by Dr. De Jaager in the following manner* It was pre-

. concerted tnat the person on whom the experiment was made should

touch the lever with his right hand when he received an electric

334 Clinical Cases. [Oct«^

shock on tlie right side^ and with the left hand when he received a
shock on that side. The interval between the shock and the signal
was found to be 0*20 of a second when the subject of the experi-
ment had been told beforehand on which side the shock would be
given, and 0*27 of a second when he had not been told; 0*07 had
therefore been employed in reflection.

M. Hirsch, again, has found that on an average two tenths of a
second must elapse before an observer can mark bv a signal his per-
ception of a sudden noise or flash of light, and MM. Bonders and
De Jaager have varied their experiments thus — one of them pro-
nounced a syllable, the other repeated it as soon as heard; when the
syllable had been agreed upon beforehand, there was an average
delay of two tenths of a second ; when it had not been so agreed
upon, of three tenths of a second. These are, however, only average
results, and subject to considerable individual variations, of which
the ^'personal equation'' of different observers of a transit is an
example well known to astronomers.

J. B. G.

CLINICAL CASES.

Some furthef Observations in reply to Certain Strictures vpon tie
Treatment of a certain class of Destructive Patients. By Edgab
Sheppaed, M.D., Medical Superintendent of the Male Depart-
ment of Colney Hatch Asylum.

The profession, that part of it, at least, which involves our spe-
cialty, is indebted to the assistant medical officer of a county asylum
for obtaining permission from his chief to publish the mode of
treatment adopted therein towards a '^ certain class of destructive
patients.^' Invited by me in general terms to a "dispassionate
consideration^' of an important subject, he puts himself individually
forward, at '^ the request of the Editors of this Journal,'' to propound
a system of which, nevertheless, he adds, he is not '' the authorised
exponent." He says that many communications have been received
by the editors '^ condemnatory of the treatment Dr. Sheppard advo-
cates, and, indeed, I may ada, of the whole tone of his paper."

But be it known that I, too, have received communications from
superintendents and other members of our association, endorsing the

1867.] (Xmical Cases. 334.

views which I have expressed, and commending me for a candour
and bold outspokenness which are regarded as *' ill-judged^' in the
county of Sussex, and are an " aspersion*' upon the "humane
treatment of the insane in the EngUsh county asylums/'

Now, though I may doubt the " considerable diffidence" of the
gentleman who has taken up the gauntlet which I have thrown
down, I have no reason to suspect his intentions or question his
capacity. But I have a right to complain, and I do complain, of
his inaccuracy, and of his importation of the indignant element into
a matter to which I invited the "careful consideration of other
superintendents, and the judicial weighing of educated men/'
. T impugn the correctness of a statement which is to the ejffect that
I '' hold up as a pattern to be followed the lamentable want of judg-
ment and skill which would reduce the great principle of non-
restraint to four bare walls and a wooden floor." For what are the
words which I did use, and upon which this most unfair interpretation
has been placed ? They are these : —

" But it seems to me that where this destructive propensity reaches
such a pitch as to render it foolish to put a man in a padded room,
or to give him any covering, there is only one course open to us
which can be called humane, because it is not connected with re-
straint. A few single dormitories ranged side by side, and lined
with kamptulicon, Imoleum, india-rubber, or some other durable yet
yielding substance, would constitute soft and pleasant surroundings
for a naked patient. These chambers might be heated, when neces-
sary, by a conunon apparatus, to a temperature varying with the
season of the year and the individual requirements of the patient,

as indicated by the thermometer applied to the skin. They

would be at once the greatest security and the greatest comfort i»
the patient."

Everywhere I speak of "soft surroundings" and " unirritating
wrappings" as the requirements of the cases under discussion, and I
specially refer to them as those in which "medical treatment, digi-
tahs, opium, the wet sheet, will not touch the malady." " Four
bare walls and a wooden floor" are not the appointments which I
advocate ; they are the very ones which I lament over and condemn.
It is true, indeed, that the author of the paper to which this is in
some sort a reply parenthetically qualifies, in one place, his previous
declaration that "four bare walls and a wooden floor" constitute
the treatment at Colney Hatch, in a certain class of cases which
" have baffled Dr. Sheppard's energies." A sensational statement
is at first postulated with indignation, only to be afterwards -qualified
in a parenthesis and with a sneer. This is not to consider a great
question philosophically and dispassionately. The advocate of a case
undertaken at " the request of the Editors of this Journal" has no
light to import, into it the element, of exaggeration*

SSd Clinical Cases. IOcf.>

But my chief concern lies in making a few observations upon
the treatment maintained and vaunted at the Sussex County Asylum
in '^ a certain class of destractive patients/' premising that I have
nowhere said more than that there are " some cases'' which digitalis,
opium, and the wet sheet, will not touch. The usefulness of these
remedies I have ever acknowledged, and my constant use of them
is the best proof which I can ofiFer of their unmistakable efficacy.
But I am unwilling to admit that they are successful in all cases, or
that their adoption is at all justifiable to the extent advocated —
'^ proclaimed" — in the last number of this Journal. Look, for in-
stance, at the case narrated on pages 184, 185, and see if it does
not bear out my statement of the occasional futility of treatment.
It is there on record that " H. F." was treated for twelve months for
noisiness, destructiveness, and filthy habits. " Purgatives, morphia,
warm baths, warm mustard baths, digitalis, packing in the cold
sheets and in the mustard sheets, all were tried in turn, bti^ mih
little or no benefit [the italics are mine], except that as the mania
passed from the acute to the chronic stage he gradually regained
his general health and became quite strong and hearty. At one
time Til. 10 doses of dilute hydrocyanic acid were given him every
fifteen minutes daily (I) until the pulse was affected, hut all with no
benefit. Finally, in October last he was placed on 5j of Liq. Opii
every three hours, and from that moment he began to mend." " Of
a surety [adds this persistent physician] this case points out how
necessary it is to persevere in treatment, how slow we should be to
come to the conclusion that the patient is incurable until all the
means at our command have had a fair trial." Different judges
may read this case differently. To me it is one of the most con-
vincing proofs I have ever met with of the complete failure of me-
dical treatment, and of the final triumph of nature in spite of a
discipline so heroic as to make one tremble. More than this, it
suggests that, considering the known power of opium, this un-
happy martyr " H. F." might have been treated by the last prescrip-
tion at an earlier period of his disease. Not that (as I think) it
would have touched him then any more than it did at a more ad-
vanced stage. But in the catalogue of fertile resources at the dis-
posal of the assistant medical officer of the Sussex County Asylum
surely 5j of Liq. Opii might sooner have found a place. There is,
however, a certain point beyond which, as it seems to me, therapeutic
treatment has no business to be pushed. It is impossible that any
one can have been subjected to such a discipline as " H. F." for
twelve months, without having incurred the greatest risks. The
responsibility of scourging a man's vitals after this sort- is tremen-
dous, and deserving of every reprobation. But nature is wonderfully
kind and restorative to some of us, and baffles the well-meant but
mistaken energies of the most enthusiastic physiciaiij while he is

1867.] Clinical Cases. 337

playfully and illogically regarding her triumphs as the result of his
skillful art.

There is another point, however, to which I am anxious to direct
attention. My indignant critic is horrified by my "startling state-
ment'^ that " it must be known to any commissioner who has been
a superintendent of an asylum of any magnitude, that numberless
patients are uncovered the whole night ; that they will stand up
naked or lie upon the bare floor, having heaped their bedding or
clothing into one corner of the room or amused themselves by tear-
ing it to pieces.^^ " Surely (it is said) this is a most gratuitous
assertion. We must presume it is true of Colney Hatch, but is it
true of any. provincial county asylum? ... It would be inter-
esting to know whether the writer has ever been in a position to
compare Colney Hatch with our provincial asylums ?'' To which it
. is answered that the writer is in such a position. If his pre-
vious knowledge had not assured him that he had in no way over-
stated the case, his recent communication from superintendents
and others engaged in our specialty would have been suflBcient to
make clear that he had not overdrawn the picture of facts, exagge-
rated their unavoidableness, or made any suggestions which are
other than humane. Perhaps even such a lesson may be learned
from the asylum blessed with the ministrations (though only in a
subordinate capacity) of one who " emphatically denies any know-
ledge whatever of such a state of neglected misery.'' His illustra-
tive cases do not bear out his accuracy, justify his indignation, or
excuse his cynical reflection upon my '^ naivete.''

In one case I read of a patient " when visited by the attendant
this morning, he was standing up in his room quite naked, and all
his things torn up." In another it is written — " Has been noisy
and destructive for the last two nights, and will not remain in bed,
wandering about the room quite naked." Then it is added, " This
poor man still lingers on in the last throes of his deadly disease, but
as long as digitalis is judiciously administered to him, he will drift
slowly but calmly to his determined end, without trouble either to
himself or his neighbours." It is to be feared that in many in-
stances this "judicious administration" (as it is termed) of so
powerful a drug as digitalis is really meant to save trouble witA the
patient and to " his neighbours," and causes the recipients of it to
" drift," not " slowly but calmly," but speedily and distressingly, to
their appointed destiny. There is no remedy which produces a
more deadly faintness and indescribable prostration than digitalis.
Although I almost invariably administer it at meal times in the beer
of the patients, there are some who, detecting it by the ejffect which
it produces, regard all that is subsequently given them to drink with
suspicion, and even positively refuse all fluids for some days, after
one dose of this medicine has been surreptitiously exhibited. But

VOL. XIII. 24

338 Clinical Case^. [Oct.,

this therapeutic scourging with the most deadly poisons — ^this med-
dlesome interference in hopeless cases — is more humane in the eyes
of young enthusiasts than '^ a warm or temperate atmosphere, unseen
but yet appreciated; yielding, but ever in closest contact, which
winds itself about the surface with a soothing tenderness, and per-
meates every pore with its gentle influences/*

Alas ! for those who are submitted to the rigorous discipline of
experimental physicians, whose chief care appears to be (at Hay-
ward's Heath) to substitute the laboured throbbings of reduced
vitality for the happy delire ambitieux of the hopelessly paralysed
and insane. Such a treatment may be countenanced by some to
whom "faulty physiology^' is unknown, who never propound '* start-
ling theories,'' make " inaccurate observations," or write '^ ill-judged
papers/' It may command the approval of constituted authorities ;
it may excite the interest and curiosity of the scientific ; it may even
earn the pseudonyme of '^ philanthropy,*' that name which seems to
cover and embrace a multitude of follies. But it is of a surety based
upon a false conception of the wants and exigences of disease, and
of a mistaken estimate of the appliances which that disease requires.

There is something within which tells me that nothing can justify
this pushing of an heroic remedy to such an extreme as is advocated
in the last number of our Journal. Something without gives me
the same assurance. My own observation tells me that where the
processes of disease cannot be lessened by violent drugs (as in ge-
neral paralysis), and the fatal issue is clearly determined, there is no
excuse for their extreme exhibition. For, indeed, there is no com-
parison which is not in favour of the first, between the happiness of
such a subject, treated as I have proposed to treat him, and the same
incessantly tormented by an officious physician and attendant clothing
his outside with overheating garments, and his inside with depressing
and nauseating medicine " in this philanthropic age." Other eyes,
too, see as I see, and other tongues inquire to what extent this
*' humane treatment {is it humane ?) of insanity" is to be carried.
Some of our associates at our late annual meeting expressed to me
their astonishment at the unmeasured and immodest terms in which
an assistant medical officer (laying claim to '^ considerable diffidence")
has branded with *^ condemnatory" my well-matured statement and
avowed belief.

But what answer is given — what answer is attempted to be given —
to the typical case of 'acute mania which I placed on record, the like
of which I have seen "over and over again," where the patient
alludes in terms of gratitude to his permitted nudity — to the reUef
it was to him and to the remembered " terrible insupportableness of
his clothes ?" The fact is there is no legitimate answer to be given
to it. My friend Dr. Davey spoke to me on this matter at our late
amiual meeting. He has practised our specialty in a tropical

1867.] Clinical Cases. 339

climate, seen " the naked negro panting at the line/^ and would then
as soon have thought of wrapping up a destructive lunatic in cob-
webs (as he happily expressed it) as of fettering him with any sort
of clothing. It is not permitted to us here to obey the sober
teachings of nature, not even if we create the artificial surroundings
of an elevated temperature. The hard, the tangible, the objective,
must take precedence of the soft, the intangible, the subjective.
How is thisr It is so written in the books. A self-created and
delusive standard of happiness is set up, and we must assimilate
everything thereto. Anything else is inconsistent with ^^ the modern
treatment of the insane,^^ "admits of no sort of justification.''
Nudity and '^ neglected misery'' are identical terms. It is more
charitable to ply a man for twelve months with drugs, digitalis,
prussic acid, in 171.10 doses every fifteen minutes, &c. &c.

"If the perfection of treatment (I repeat) is manifested by its
adaptiveness, and by the relief which it affords to the patient as
evidenced by its immediate results, and by his subsequent confession,
surely he is a bold man who will question its theoretical and practical
soundness."

But such a man is to be found in Sussex, pasturing upon the
downs of that beautiful county. He writes of my '^startKng
theories" and ^' inaccurate observations," and says that " my phy-
siology when weighed in the balance appears to be as faulty as my
treatment."

Is this really so ? Let us see.

" I may premise (it is written by my censor and critic) that I
take the normal temperature of the human body to be 98° 4', that
being the degree settled by Dr. Ait ken." I do not say that it is
not so. But the average axilla temperature of four healthy and
robust men, taken by me about ten at night, on three separate occa-
sions, was 96° 7', the back or chest temperature being 94^ 3\
The average axilla temperature of four patients, destructive and
maniacal, taken in the same way and nearly at the same time on
three separate occasions was 98° 3', the back or chest temperature
97°. But, to speak truly, the thermometer is not really needed to
indicate hypersesthesia or the general requirements of an insane
skin. The hand passed over it ; the eye directed to the general
condition of the patient, will tell an experienced physician what is
needed, to what extent treatment is required, and to what lengths it
may be pushed. But I am certain that where the thermometer is
used an increase of temperature will be found to accompany an
increase of maniacal excitement, and that hypersesthesia also is a
common attendant. Again, it is urged, ^^We must look to the
cause of the symptoms, not at the periphery, but in the nerve-centres.
Towards these, then, should our plan of treatment be directed."
Indeed ! Let me then in my simplicity inquire what is the use and

340 Clinical Cases. [Oct.,

what is the mode of action of the wet sheet, the mustard bath, the
Turkish bath, and those other external appliances which are com-
monly regarded as peripheral in their operation and influence ?

And further, is there any direct proof that the hypersesthesia of
skin is in the ratio of its elevation of temperature ? In most cases
it would seem to be so. Discussing on the physiology and pathology
of the central nervous system. Dr. Brown-S^quard alludes to the
condition of animal heat in cases of alteration of the spinal cord
and the encephalon, which certainly will include the "general
paralysis of the insane.''

His conclusions are — " 1st. That usually anaesthesia is accom-
panied by a diminution of temperature. 2nd. That hypersesthesia
almost always coexists with an increased temperature. 3rd. That in
paralysis, without either a notable hypersesthesia or anaesthesia, the
temperature is nearly normal/'

And he gives his reasons for these conclusions : *' In anaesthetic
parts the blood-vessels are usually contracted, and, therefore, there is
less blood in them, and also a lower temperature. In hyperaesthetic
parts the. reverse exists."*

This exactly bears out the opinion which I expressed in my first
paper. I am content that my " faulty physiology" should assimilate
in some sense to that of a physician of world-wide reputation whose
name is Brown-Sequard, though, of course, I deeply regret that it
does not meet the approval of one whose name is prefixed to the
article which calls for this reply.

It is only necessary for me to add that I see no reason from what
has occurred and what has been written to alter my views upon the
'treatment of a certain class of destructive patients." What I
have advocated cannot be carried out as long as men are slaves to
''conventional thinkings," toy with subjective philanthropy, and
turn with shuddering indignation from the objective teachings of a
large experience.

If men situated as I am would have the courage to come forward
and say what they think, and claim the right to practise what they
believe, it would free the specialty from a dictatorial thraldom to
which another branch of the profession is exposed, and which is
most injurious to the moral well-being of medical superintendents of
asylums. For myself, though the law may place it out of my
power to practise, I will never cease to declare what I believe to be
true and humane respecting the treatment of those unhappy persons
in whom I am so deeply interested, and to ameKorate whose condition
I am devoting the best energies of my life.

* * Course of Lectures on the Physiology and Pathology of the Central Nervona
System/ p, 202,

1867.] 341

PART 1 1. -REVIEWS.

Be la Folie Raisonnante et de Vimportance du delire des actes jpour
le diagnostic et la medecine legale. Par A. BaiERaB de Bois-
MONT. Paris, 1867, pp. 95.

The indefatigable M. de Boismont has lately added another to
the long list of his published works, and this last arrival is not
less welcome than its predecessors. It is, indeed, encouraging to
see the earnestness with which a man so celebrated in his spe-
cialty still labours to give his confreres the results of his ripe
experience, and through them the public at large, thus conferring
a double benefit. There is, perhaps, no subject on which the
public require so much to be enlightened as on insanity, and none
of which the general ignorance works more harm. Every fresh
trial shows how faulty are the notions of even educated and in-
telligent men on this subject, and how absurd are some of the
judicial fictions, based as they are on the errors and want of
observation of half a century or more ago; we can, then, hardly
wonder that the unreflecting and credulous public should follow
in a similar track.

There is no better remedy for such a state of things than the
extensive record of well-observed facts and cases, for the cumu-
lative force of such evidence tells in time and carries a weight
which is denied to the ingenious theories of original speculation.
M. de Boismont's last contribution is of this useful though un-
pretending character, and is a sort of running commentary on
five and twenty cases of a class which we in this country are in
the habit of calling " moral " insanity. By this term we would
not imply mere cases of vicious habits or ill-regulated passion with-
out intellectual disturbance, but also those of altered character,
disordered affections, and perversities of disposition, noticed with
exaltation or depression, illusion, and epilepsy, or alternating with
such conditions.

Such cases are a lesson to those who can only see insanity in either
the raving or idiotic ; and we agree with the author, that the best
cure for such a creed is to lay before the public a few " portraits
after nature'' of this '^ reasoning madness.'' "If," he says, ''there
ever was a fact determined by practical experience, it is this, viz. the
existence of a class of the insane who can talk, write, and act for
hours together, and even longer, with every appearance of reason.

342 Remews. [Oct.,

Keasonable language and foolish actions have their analogues
in tlie world. Is it not, indeed, the ordinary habit of a number
of people who, after having charmed one by their cleverness and
reasoning, proceed to risk their fortune, their life and honour, in
the most foolish and compromising enterprises? These analogies
are especially evident in the morally insane, and the cases we are
about to relate show that these patients speak, write, and behave
themselves like other men in their lucid intervals and when they
are on their guard; but when they return to asylum life and are
subject to daily observation they show their real character, and
in the immense majority of cases, their acts, and often even their
words, dissipate all doubts.'^

The following case (Obs. 3, p. 10) is an instance of mania, as
evidenced by the acts of the patient, without incoherence : — '^ Made-
moiselle J., set. 21, whose mother was weak-minded and devoid of
resolution, has been several times placed in my establishment for
attacks of mania which seemed to originate in disappointments in
marriage. This young lady becomes very anxious to ask questions,
demanding an explanation on every subject, so that every one avoids
her to escape the torment. When the attack is fully developed her
actions offer the most painful contrast to her words. She tears off
portions of skin ; covers the walls with her excrement, throwing it
into her bed or secreting it in her mattress. She removes the
horsehair from the furniture, the feathers from her pillows, and
destroys her clothes. If her conduct is remarked on, she replies
that her malady overpowers her ; that she suffers dreadfully from
ennui ; and that she acts thus to bewilder herself and give another
course to her ideas. Is there, she says, anything more horrible than
to be shut up with lunatics ? Death is a hundred times preferable to
such a position ; it would be far better to take me back to my
mother ; I should then be cared for at home, and I should escape
from this scene and these thoughts. In her periods of excitement,
which last for weeks, sometimes a month or two, she does not talk
incoherently, she refers all that she has said to her malady, of which
she is quite conscious. Her cries, her fury, her actions, her agita-
tion, are only, according to her, the consequence of her state of suf-
fering \ one has to yield to her request to leave, but when she has
got home she finds it impossible to remain there. She disappears,
goes off by the train, is searched for in all directions, and has to be
Drought back to the asylum.

"This young lady, who is of agreeable manners and well off,
wishes to marry, and several suitable persons have made her offers
since her return into society, but her disease has left an irresolution
which, happily, puts obstacles in the way of every offer, for insanity
is constantly in view. On several occasions the engagements have
gone so far that presents have been bought and the day fixed, &c..

1867.] Reviews. 343

but at the last moment she has abraptly broken it off, and often
with very harsh speeches. No sooner has she done this than she is
seized with the most lively regrets and makes attempts to renew it ;
and this has gone on for years/'

Hypochondriasis aod melancholia, when not very well marked, and
even when of the ordinary type, are often at their commencement
attended by symptoms of moral insanity, and are not unfrequently
misinterpreted by those unacquainted with the insane. In such cases
the patients appear reasonable, have no delusions, can distinguish right
from wrong, and behave themselves properly, but on closer exami-
nation, a change in disposition is noticed and their affections undergo
a complete change; they become irritable and malicious. Such
cases prove very troublesome to every one, both to friends and
doctors, and our author gives several illustrations from his own
experiraice.

These symptoms may coexist with delusions, or tendency io
suicide, and are sometimes associated with impulsive mania and
give rise to acts of violence.

The following case is a good example of the course pursued by
some of these patients, and the misery and annoyance tliey cause to
others : —

" Madame G., set. 55, of strong constitution, and sanguine, ner-
vous temperament. Among her near relations is one who is imbe-
cile ; and one of her parents, a very eccentric and rather immoral
man, set her the example of strange conduct, and in early life
poisoned her mind by loose reading. Her conversation and letters
give evidence of an intelligent and cultivated mind, and it would be
difficult to discover when she is on her guard or during her lucid
intervals any trace of intellectual derangement. Married to an offi-
cial of high rank, her instinctive tendencies soon manifested them-
selves, and her vagaries became so notorious as to involve a speedy
judicial separation. She was first placed in a religious establishment,
but her conduct was such she could not remain there, and she was
brought back to her father's house, where she behaved in such a
manner that her further residence was impossible. Her restlessness
and the inequality of her temper, her threats, paroxysms of fury, and
acts which had not even the excuse of passion, forced her husband
to place her in an asylum. This was the first trial. Madame G. made
use of all the resources of her mind, caused a disturbance in the
establishment, made an attempt at suicide, wrote letters to the
authorities, and succeeded in regaining her liberty.

The hatred with which her husband had inspired her, and which
her frequent seclusions had increased, suggested to her a plan which
caused him the greatest annoyances. She wrote anonymous letters,
so much the more dangerous and perfidious since they entered into
the most private affairs and could only be incompletely answered.

314 Reviews, [Oct.,

Every time that she practised this manoeuvre she succeeded in
doing her husband some injury, though the author of the mischief
was not known.

" Having regained her hberty, Madame G. gave herself up to the
unrestrained gratification of her passions, and her husband was
driven, for the sake of her children as well as herself, to shut her up
again. She was placed in an asylum to which we were attached.
Her antecedents and mental disease made us alive to noticing her
words and acts. When things went as she liked she behaved
agreeably, only it was needful to keep at a distance, for there was
no rest while any man was near her. Young and old, gentlemen
and servants, were all the same, and one could feel no security
while she was within reach of any of the male sex.

" The variations in her temper were extreme. She talked, got
angry, laughed, wept, and refused to speak by turns ; and when
vexed, if you made a simple observation, she went into a great
passion and poured forth a torrent of abuse. After having had
recourse to every possible artifice to attain her object, she made
the establishment the object of her attack, and sent letters to the
authorities. A magistrate came to examine* her, and listened to
the account given him, but though he might have had confidence
in the director, yet, dazzled by the very clever defence of Madame
G., who laid all her wrongs to her husband to whom she attri-
buted all her misery, he raised some objections to which it be-
came necessary to reply. It was needful to acquaint the husband,
who, after having seen the Procureur Imperial, was obliged to
take his wife back again. Perhaps, also, the father, who could
never quite believe in the madness of his daughter, may have con-
tributed to this result.

" Two years passed without any great complaint. This lady lived
with her father, but at last her inequalities of temper, rages, and
vagaries were too much for the love and patience of him who was
her only friend and protector. This time it was with his consent
that she was brought back to the asylum where she had been placed
on the last occasion. When we saw her the day after her admission
she smiled and said, ' Since they insisl^that I am mad, and have even
made use of an artifice to confine me, I prefer to be sent to your care.
I believe you to be an honest man, and am convinced that after
having observed and recognised the tranquillity of my mind and con-
duct, you will order the doors to be opened for me. I do not now
wish to return to my father's, but I should ask to be received into a
convent, or in an ordinary boarding-house, where I could go in and
out as I please.' Madame G. did not talk incoherently now any
more than she did at first. Her conversation, when she was pretty
contented, was lively, brilliant, and often impassioned, but never
exceeding proper bounds. Her reproaches of her husband's conduct

1867.] Reviews. 345

appeared to have some foundation, and might easily have imposed
on people if they had not been misled by her perfidious character
and anonymous letters. She soon became amorously disposed
towards the doctors, the director of the establishment, and his rela-
tions, made them each propositions before their wives, and wrote
them letters and verses. This lady, despite her mental attainments,
and forgetful of the ravages of time, would show herself barely
covered, and when she thought she was alone, had but little respect
for decency. A word or gesture of disapprobation was enough to
excite her anger to the utmost, she filled the house with complaints,
cries and abuse ; she rolled on the ground with her hair and dress
in disorder, or else she gave herself up to a fit of despair which ren-
dered it needful to have her carefully watched ; she would then ask
to change her abode, and recommenced her complaints of arbitrary
detention. Under other circumstances she was ironical and given
to sneer at and ridicule everything said to her. Impressionable,
and changeable to the last degree, she would turn her back on those
she best Eked for a whole day for a mere trifle, and often without
any apparent cause, and then return with the same cordiality as
ever, melting into tears, and bursting out laughing as though her
friendship had never been interrupted. To see her in these moods,
which were of very frequent recurrence, one would never have
doubted but that she might have been kept at home, but her self-
control altered her as she chose. Before a stranger she assumed a
calm demeanour, and entered into conversation without betraying
any signs of her mental malady. On several occasions she has
mixed in society and behaved herseK most properly, not giving way
to her feelings in any way.

'^ This case from its nature gave rise to many complications, and
the patient^s discharge was several times ordered by the authorities,
but the interposition of the Procureur was requested. This func-
tionary, after listening to all sides, visited her apartment. He found
the walls covered with pictures, flowers, ribbons, letters, papers, and
decorations, the arrangement of which and their oddity showed at
once the disorder of her imagination, and the Procureur said the sight
of this satisfied him, and that her proper place was in an asylum.^'

We have given this case at length as a good illustration of a
class. It is not uncommon for this form of insanity to show itself
at the commencement of general paralysis, but it is seen in a very
characteristic manner in the case of chronic alcoholism, i. e, in those
who drink in paroxysms. Such cases are well known in private
practice, and the difficulty of retaining them legally is not one of
their least troublesome features* Speaking of this, M. de Boismont
says : —

'' We have had charge of many ladies well brought up, who have
been found half-naked in very low places, who on coming to them-»

846 Iteviefos. [Oct.,

selves have found a thousand specious reasons to explain, justify, or
even deny their conduct. At first they were kept at their own
homes, for their reasoning was so clear that the authorities refused
to allow their seclusion ; but their disgraceful conduct, so little in
accordance with their rank, their education, and the scandalous
scenes they caused, have in the end convinced the powers that be,
and they have been shut up. Once in confinement, no trace of
mental disorder showed itself, but then began the appeals and com-
plaints to the magistrates, plots and disorder in the establishment,
and more than once there was no other course open than to send
these ^reasoning lunatics' back to their families; however, to
gratify their deplorable inclinations, they would stop at nothing,
and several abandoned themselves to the lowest companions. This
form of insanity is so familiar to us that we now refuse to take
such patients.*'

There remains another class of the insane liable to these symp-
toms, viz. epileptics, and in them it may be followed by terrible
consequences — murder and suicide having often been the result, as
illustrated by the murder of two attendants at the Marseilles Asy-
lum only last year. Of this class Trousseau said, '^K a man,
without any previous intellectual disturbance, and without having
hitherto shown any sign of excitement, without being under the
influence of alcohol or any other substance exercising an energetic
action over the nervous system, commits suicide or kills any one, that
man is an epileptic.''

It is these cases of moral insanity that the public cannot imder-
stand, and which so often get liberated when their wrongs are
brought forward, to the great damage of society, friends, morahty,
truth, and science, and for illustrations we can refer the sceptical to
M. de Boismont's pages. There is one point in its diagnosis which
deserves especial consideration, and that is the influence of here-
ditary taint, and also of the antecedents of the patients. Thus in
the twenty-five cases alluded to it was found that one of the patients
was half imbecile from birth; another was epileptic, with also
derangement of the intellect ; seven were odd, eccentric, irritable,
unstable, and irresolute, and of these, one had had a previous attack
of insanity. But the most distinctive character is the insanity of
the acts, while the reasoning is clear and the language coherent. It
is this, too, which so often gives rise to so much misery to others,
the patients being generally malicious, if not violent, and disposed
to every degrading passion. M. de Boismont says towards the
close of his pages —

" The relation of the facts contained in this work is, for every
enlightened man, a proof of the existence of a variety of lunatics who
can speak, write, and act for a longer or shorter period with every
appearance of reason. The first conclusion to be drawn from the

1867.] Eeviews. 847

examination of these patients is, that the reasoning powers are sus-
ceptible of being deranged and injured in their functions in the same
way as those of the heart, lungs, or stomach. The second inference,
not less important, is, that insanity, like other diseases, is governed
by laws like those regulating health. It is, then, essential, in order
to study the insane, to fully understand the sane man who must be
taken as the starting-point. The third conclusion is, that insanity
may show itself while the reasoning powers remain, although the
idea on which it rests is false, a matter which much increases the
difficulty of diagnosis as regards questions of legal medicine.^^

The conclusions with which M. de Boismont sums up his work
are as follows : —

''1st. There exists a variety of insanity in which the patients
express themselves with every appearance of reason, and which is
styled 'reasoning madness' (in English, moral insanity); the
knowledge of it being acquired all the better by studying the sane
man, from whom the lunatic is a mere deviation.
• " 2nd. This variety of insanity is observed under different forms,
but more particularly in that of maniacal excitement, melancholy,
itnpulsive monomania, and the alternating states, &c.

" 3rd. This manifestation of insanity, which is only a symptom,
may be sometimes so prominent that the secondary may seem to take
the place of the primary disease. Prolonged observation generally
discovers in the end some of the principal symptoms of insanity.

" 4th; Moral insanity presents as its distinctive characters insane
actions, and bad animal propensities, with rational conversation.
Observation shows that, when there is no great excitement, and the
patient is not on his guard, intellectual disturbance may then often
be apparent in conversation.

" 5th. They may continue to use reasonable language in writing,
but> when these patients are studied for some time, the insanity of
their actions reveals itself also in their writings.

" 6th. The recognition of moral insanity is the more important in
its relations to legal medicine, inasmuch as these patients are dis-
posed to do wrong. Among the ordinary acts of the morally insane
are calumnious or anonymous statements, plots, slandering, lying in
every form, dishonorable actions, homicide, suicide, accusations of
violence, theft, immorality, lawsuits for arbitrary detention, claims
for damages, &c.

" 7th. There exists an important difference in character between
the sane and morally insane ; the former, when they are not criminal,
generally repress or repent of bad impulses when they have given
way to them, but the latter,, not thinking themselves in fault, hardly
concern themselves about such acts, nor consider them worthy of

blame.

^ 8th. Another characteristic, not less important, is the impossi-

848 Reviews, [Oct.,

bility of these patients keeping to one thing or showing any stabiUty
of purpose during the persistence of their disease.

"9th. Lastly, when the morally insane conceal their morbid
ideas^ causing doubts as to their reality, and do not commit inju-
rious acts, the only course is to leave them at liberty, warning them
they are the arbiters of their own fate."

G. M. B.

Inaugural Address delivered to the University of St. Andreta^s,
February 1st, 1867. By John Stuart Mill, M.P., Eector
of the University.

CoMPLYiNO with the custom, which he holds to be highly com-
mendable, of embodying in an address some thoughts on the sub-
jects which most nearly concern a seat of liberal education, Mr.
Mill has taken the opportunity of his inauguration as Rector of the
University of St. Andrew^s to express his opinions upon what should
be the character of university education. It has become a great
question of the day whether general education should be classical or
scientific; a dispute going on in a smouldering way, and occa-
sionally lighting up into fierceness, as to the superiority of the
ancient languages or of the modem sciences and arts. To impartial
on-lookers it is sufficiently plain that the champions of each cause
are far too one-sided ; they are acutely alive to the merits of their
own case, singularly blind to the merits of the case which their ad-
versaries present. It is the old story, as old as life : has the shield
a golden or a silver side ?

'' This question, whether we should be taught the classics or the sciences,
seems to me/* says Mr. Mill, ^' very like a dispute whether painters should
cultivate drawing or colouring, or, to use a more homely illustration, whether
a tailor should make coats or trousers. I can only reply by the question,
why not both ? Can anything deserve the name of a good education which
does not include literature and science too ? If there were no more to be
said than that scientific education teaches us to think, and literary education
to express our thoughts, do we not require both ? Can anything deserve the
name of a good education which does not include literature and science too ?
If there were no more to be said than that scientific education teaches us to
think, and literary education to express our thoughts, do we not require
both ? And is not any one a poor, maimed, lopsided fragment of humanity
who is deficient in either ? We are not obliged to ask ourselves whether it
is more important to know the languages or the sciences. Short as life is,
and shorter still as we make it by the time we waste on things which are
neither business, nor meditation, nor pleasure, we are not so badly off that

1867.] Reviews. 349

our scholars need be ignorant of the laws and properties of the world they
lire in, or our scientific men destitute of poetic feeling and artistic cultiva-
tion."

Granting all this as theoretically most desirable, it may perhaps
be objected that human life is short ; that only a small part of it
can be devoted to education in a world in which no manna drops
from heaven, no benevolent ravens come with eager flight to feed the
hungry ; that the race of life is on the whole to the swift, and the
battle of life to the strong ; and that the swiftness wanted in the
rude struggle for existence is not the swift flight of a cultivated
imagination, the strength wanted not the strength of poetic feehng^
It may be asked whether it is not more to a man^s advantage, who
has his way to make in this rude world, to be destitute of the deli-
cate grace of cultivated feeling and of the torturing ingenuity of an
acute and active imagination. By thinking too precisely on the
event, and by bending his course in accordance with the sensibihties
of delicate feelings, a man is very apt to be pronounced not practical,
and to be considered of small hope in the world. He will be quite
as badly off if he carry his imagination beyond the things that are
immediately under his eye, and get the reputation of a visionary or
fanatic. This is an aspect of the question which Mr. Mill does not
enter upon, and it was unnecessary to do so. What he does point
out very forcibly is how strangely limited is the estimate usually
made of what it is possible for human beings to leam.

** So narrow a conception," he says, " not only vitiates our idea of educa-
tion, but actually, if we receive it, darkens our anticipations as to the future
progress of mankind. For if the inexorable condition of human life make it
useless for one man to attempt to know more than one thing, what is to
become of the human intellect as facts accumulate ? In every generation,
and now more rapidly than ever, the things which it is necessary that some-
body should know are more and more multiplied. Every department of
knowledge becomes so loaded with details that one who endeavours to know
it with minute accuracy must confine himself to a smaller and smaller por-
tion of the whole extent ; every science and art must be cut up into sub-
divisions until each man*s portion, the district which he thoroughly knows,
bears about the same ratio to the whole range of useful knowledge that the
art of putting on a pin's head does to the field of human industry. Now, if
in order to know that little completely it is necessary to remain wholly igno-
rant of all the rest, what will soon be the worth of a man for any human
purpose except his own infinitesimal fraction of human wants and require-
ments. His state will be even worse than that of simple ignorance."

Mr. Mill is of opinion that there is no ground for so dreary an
anticipation ; on the contrary, he is convinced that it is quite possi-
ble to combine a minute knowledge of one or a few things with a
general knowledge of many things, understanding by general know-
ledge not a superficial knowledge, but a true conception of the sub-
ject in its great features. The minor details should be left to those
who require them for the purposes oi their special pursuit ; it is

350 Review9. [Oct.,

idle to throw away time apon the details of anything which is to
fonn no part in the occupation of our practical energies.

It by no means follows, however, that every useful branch of
general knowledge should be included in the curriculum of school
or university studies. The modem languages may be much more
easily acquired by intercourse with those who use them ; a few
months in the country itself, if properly employed, go so much
farther than many years of school lessons, that it is really waste of
time for those to whom the easier mode is attainable to labour at
them with no help but that of books and masters. The only lan-
guages and the only literature to which Mr. Mill would allow a
place in the ordinary curriculum, are those of the Greeks and
Bomans ; and to those he would preserve the position in it which
they at present occupy. If this be done, we fear there will be very
little margin left for improvement. The practice of translating with
accuracy from one language to another Mr. Mill believes to be the
best corrective of the tendency of mankind to mistake words for
things ; and he holds the Greek language to be the best for this
purpose. It may be doubted whether his ' scientific readers will
agree with him in this opinion. Much of Greek philosophy consists
of vague words having no precise and definite facts beneath them,
and it is not easy to perceive how a youth will profit greatly by
translating thought that has meaning into words that have none.
The study of some modem languages embodying the acquisitions of
modem philosophy and the results of science, would seem far better
fitted to secure exact attention to the meaning of words. The re-
searches of science have in fact given exact definitions, and made known
the relations, of a multitude of facts about which Greek philosophy
vainly and vaguely speculated ; and not the least of the evils spring-
ing from the present system of university education is that on ac-
count of the large esteem given to Greek literature, and the small
esteem given to science, many people go on through life mistaking for
philosophy empty abstractions with pretentious names, which have
no meaning when brought to the test of facts. The philosophy of
the schools now is very much what the philosophy of the schools
was in Bacon^s time — an elaborately constructed net of words en-
snaring for life many minds that deserve a better fate. What the
advocates of scientific education demand, and very justly demand, is
that the university curriculum should be so modified that those who
are being trained there should be made acquainted with the facts of
the universe so far as they are known, apart from the names which
any school of ancient philosophers may have chosen to give to such
obscure intimations of them as they had ; for we may assume it to
be necessary in the long run that the human intellect be nourished
not on names, even though these be Greek names, but on facts.
Having given these opinions, we shall make no comment on the

1867.] Reviews. 351

foUowing passage : — "Modern phraseology never conveys the exact
meaning of a Greek writer; it cannot do so, except by a diflFuse ex-
planatory circumlocution which no translator dare use. We must
be able, in a certain degree, to think in Greek if we would represent
to ourselves how a Greek thought ; and this not only in the abstruse
region of metaphysics, but about the political, religious, and even
domestic concerns of life.'' Certainly it would require a considera-
ble circumlocution to make intelligible to the student of modern
metaphysics the Greek's ideas regarding the first principle of things,
the unchangeable essences or entities of which phenomena were but
the changeable manifestations, and the hierarchy of souls. Nor, we
think, would it conduce much to a student's advantage if it were
done.

Let it not be thought that we undervalue the liberalising, refining,
and enlightening influence of the study of Greek and Latin authors.
Far from it ; we appreciate such benefits as highly as Mr. Mill can ;
but we feel that he is not penetrated with the spirit of modem
science, that in respect of certain subjects he belongs to an epoch of
thought which is almost past, that he fails therefore to appreciate at
their proper value the far-reaching claims of science, and unwittingly
assigns to Greek and Eoman literature too prominent a position in a
scheme of education. The time available for a university training is
Umited ; the matter for study is really unlimited ; and the question
is so to proportion different studies as to lay the best foundation of
future development. We cannot help thinking that if the student
has to study Greek so thoroughly that he shall be able to think in
Greek, he will have done what he ought not to have done, will have
left undone what he ought to have done, and that there will be but
little health of mind in him.

It will be gratifying to those who remember how lightly Mr.
Mill has spoken of physiology in his earlier works, and even until
quite recently, to perceive that he has now awakened to a feeling of
its importance.

" The practice which it gives in the study of nature is such as no other
physical science affords in the same kind, and is the best introduction to the
difficult question of politics and social life. . . . Take what view we
will of man as a spiritual being, one part of his nature is far more like
another than either of them is like anything else. In the organic world we
study nature under disadvantages very similar to those which affect the
study of moral and political phenomena ; our means of making experiments
are almost as limited, while the extreme complexity of the facts makes the
conclusions of general reasoning unusually precarious on account of the vast
number of circumstances that conspire to determine the result. Yet in
spite of these obstacles it is found possible in physiology to arrive at a con-
siderable number of well-ascertained and important truths. This therefore
IS an excellent school in which to study the means of overcoming similar
difficulties elsewhere. . . . Physiology at its upper extremity touches
on psy^olc^, or the philosophy of mind; and, without raising any disputed

352 Reviews, [Oct.,

questions about the limits between matter and spirit, the nerves and brain
are admitted to have so intimate a connection with the mental operations,
that the student of the last cannot dispense with a considerable knowledge
of the first."

Were it not perhaps better if the student of the last had more than
a considerable knowledge of the first ? The portion of physiology
which touches on, or, more correctly, which underlies, psychology
is the most complex and difficult department of the science, and to
get anything like just conceptions of it there is required a full and
exact knowledge of all those departments of physiology that are con-
cerned with structures lower in the scale of life than the nervous
system. In reality, it is an acquaintance with the whole region of
organization, at the head of which stands the nervous system, that
the student of psychology must make up his mind he cannot dis-
pense with. Only so will he be able to acquire an order of concep-
tions essential to the interpretation of the phenomena of the mental
organisation. There is no miraculous virtue in physiology to inspire
with intuition the psychologist who touches only the hem of its
garment. And, however unwilling he may be to believe the fact, it
admits of no dispute now, that the question between him and the
physiologist concerning mental phenomena is not a question of one
of the two having some smattering of the doctrines of th^e other,
but a fundamental question of method of study.

But we must hasten to make an end of these remarks. It is
impossible to give a just idea of Mr. Mill's admirable address by
short extracts and desultory commentaries. Pregnant with sug-
gestions for reflection and discussion, it deals with many more
subjects than those to which we have adverted. Animated with
earnest feeling, its language at times is well adapted to awaken
noble aims and generous aspirations. We quote the concluding
remarks, —

" And now, having travelled with you over the whole range of the mate-
rials and training which an university supplies as a preparation for the
higher uses of life, it is almost needless to add any exhortation to you to
profit by the gift. Now is your opportunity for gaining a degree of insight
into subjects larger and more ennobling than the minutiae of a business or a
profession, and for acquiring a facility of using your minds in all that con-
cerns the higher interests of man, which you will carry with you into the
occupations of active life, and which will prevent even the short intervals of
time which that may leave you from being altogether lost for noble purposes.
Having once conquered the first difficulties, the only ones of which the
irksomeness surpasses the interest ; having turned the point beyond which
what was once a task becomes a pleasure ; in even the busiest after-life the
higher powers of your mind will make progress imperceptibly, by the spon-
taneous exercise of your thoughts, and by the lessons you will know how to
learn from daily experience. So, at least, it will be if in your early studies
you have fixed your eyes upon the ultimate end from which those studies
take their chief value — that of making you more effective combatants in the
great fight which never ceases to rage between good and evil, and more

1867.] Reviews. 353

equal to coping with the ever new problems which the changing course of
human nature and human society present to be resolved. Aims like these
commonly retain the footing which they have once established in the mind :
and their presence in our thoughts keeps our higher faculties in exercise,
and makes us consider the acquirements and powers which we store up at
any time of our lives, as a mental capital, to be freely expended in helping
forward any mode which presents itself of making mankind in any respect
wiser or better, or placing any portion of human affairs on a more sensible
and rational footing than its existing one. There is not one of us who may
not qualify himself so to improve the average amount of opportunities, as to
leave his fellow-creatures some little the better for the use he has known
how to make of his intellect. To make this little greater, let us strive to
keep ourselves acquainted with the best thoughts that are brought forth by
the original minds of the age, that we may know what movements stand
most in need of our aid, and that, as far as depends on us, the good
seed may not fall on a rock and perish without reaching the soil in which it
might have germinated and flourished. You are to be a part of the public
who are to welcome, encourage, and help forward the future intellectual
benefactors of humanity ; and you are, if possible, to furnish your contin-
gent to the number of those benefactors. Nor let any one be discouraged
by what may seem, in moments of despondency, the lack of time and of
opportunity. Those who know how to employ opportunities will often find
that they can create them, and what we achieve depends less on the amount
of time we possess than on the use we make of our time. You and your
like are the hope and resource of your country in the coming generation.
All great things which that generation is destined to do, have to be done by
some like you ; several will assuredly be done by persons for whom society
has done much less, to whom it has given far less preparation than those
whom I am now addressing. I do not attempt to instigate you by the pros-
pect of direct rewards, either earthly or heavenly ; the less we think about
being rewarded in either way the better for us. But there is one reward
which will not fail you, and which may be called disinterested, because it is
not a consequence, but is inherent in the very fact of deserving it — the
deeper and more varied interest you will feel in life, which will give it a
tenfold value, and a value which will last to the end. All merely personal
objects grow less valuable as we advance in life ; this not only endures but
increases."

Excerpta from the Annual Reports for 1866 of the County and
Borough Lunatic Asylums and Lunatic Hospitals of England
and Wales.

All the public lunatic asylums of the country having by this
time published their annual reports, it behoves us again to examine
their contents, and endeavour, as far as is in our power, to extract from
each whatever may seem to us to be of interest and utility to the
general readers of this Journal. It is gratifying to observe that
an increased number contain the statistical tables recommended by

VOL. XIII. ^5

354 Beviews. [Oct.,

the Medico-Psychological Association, and sanctioned, and in trath
lauded, by the Commissioners in Lunacy in their last report.
Indeed, those reports not containing these tables form the exception,
not the rule, and we dare hope that ere long even many of them will
help to swell the majority, for in looking through these reports,
although the reader may be fully and very properly impressed with
the amount of useful information they contain, he is soon lost in the
endeavour, if he be rash enough to make the attempt, to turn the
knowledge therein found to any practical utility; therefore any
approach to uniformity is much to be desired, and it behoves all
" good men and true to use their best endeavours to compass the
evil by all the means in their power. Although these reports are
plentifully distributed, and the public have nowadays ready means
of ingress into most of our large asylums, it is surprising how igno-
rant many people are concerning them and their inmates. Thus, the
^ British Medical Journal,^ in a recent number, has noticed an article
lately published in the 'Pall Mall Gazette,' in which the writer
" broadly afiBrms that the lunatic asylum has its attraction for the
honest pauper as the gaol has for the idle thief,'' with more to the
same effect. This is almost totally untrue, and the ' British Medical
Journal' is quite correct in affirming that the writer has been very
ill-informed; indeed, the very reverse is the fact, for it is a most
rare thing to find a lunatic willing to remain in an asylum an
hour longer than he can help, and we have often and often been
amazed by patients begging to be allowed to leave an asylum, even
if it be but to go to the workhouse, rather than remain deprived of
liberty and under the stigma of being a lunatic, although they may
be receiving every possible indulgence short of complete freedom.

In critically examining these reports there is one little point that
we should think cannot fail to strike the unbiassed observer as a
decided injustice, if not an absolute wrong. We refer to the low
amount of salary offered in many asylums to the assistant medical
officers as compared with that enjoyed by the medical superinten-
dents. Whilst such an injustice continues can it be wondered at
that one seldom meets a medical superintendent that he does not
complain bitterly of the difficulty of obtaining competent and well-
conducted assistant medical officers, and that we so frequently hear
of things happening in asylums that should not, and in which the
junior medical officer is to blame. For, the emolument being so
small, the men who compete for this post in our asylums belong
almost invariably to one of two classes. In the one class we find
men who have embraced the psychological branch of the profession,
meaning to remain in it, and are therefore willing to pass a certain
number of years, receiving a mere honorarium for their services, in
the hopes of eventually gaining promotion to the superior post of
medical superintendent. In the other class, and this is by far the

1 867.] Reviews. 355

most numerous class, we find either men who have failed in other
branches of the profession, or the least successful men of the London
and Edinburgh schools. The former class, having a settled object to
gain, almost invariably make good oflBcers, but, owing to their small
number, are not easily to be obtained. Of the latter generally the
less said possibly the better. What, however, would be the result
if from £150 to £200 a year was offered? Why, instead of getting
the worse specimens from the schools, we should get nearly the best —
men well versed in the groundwork of their profession, and able and
willing to bring their young and ardent energies to bear to help to
elucidate the obscurity still clouding the science and practice of psy-
chological medicine. Besides, medical superintendents are often
absent from their duties, and it is daily becoming more manifest
that they cannot properly perform their work and remain in good
bodily and mental health without a long leave of absence, varying
from one to two or three months in each year; and during this
absence the assistant medical officer is perforce and of right the
person in charge of the asylum, and the whole responsibility of this
charge rests on his shoulders. Now, is it seemly, or even just, to
the many sane and insane persons he has unhmited control over,
that they should thus be at the mercy of, to put it mildly, an
inferior man ? Certainly not, and we trust that the day is not far
distant when this evil will be remedied. Already some superinten-
dents have taken the initiative; and we find the salaries of the
assistant medical officers in the Somerset, Northampton, Sussex,
Abergavenny, and other asylums, slowly creeping up. There is also
another point which, if altered, would very materially improve the
position of the second medical officer, namely, if the title of deputy
medical superintendent, which this officer really is, was universally
adopted, instead of the various titles by which he is at present
known.

Bucking Aamshire, — Fourteenth Annual Report on the County Pauper
Lunatic Asylum, Mr. John Humphrey, Medical Superin-
tendent.

This asylum contains 325 inmates, namely, 134 males, 191
females ; and the amount charged per head was in three quarters
9«. 4rf., and in one quarter 85. 9^. The report of the Commissioners
in Lunacy is, on the whole, favorable. The mortality during the
year was low, being only at the rate of 9 per cent, on the average
numbers resident. The inmates of this asylum are allowed as much
liberty as is consistent with their safety, and several have, during
the past year, enjoyed the privilege of spending from one to seven
days with their relatives. This is a boon that should be much

356 Reviews. [Oct.,

appreciated, or it cannot recompense the officers for the anxiety and
worry it causes.

Ninth Annual Report of the Committee of Visitors of the Cambridge^
Isle of Ely, and Borough of Cambridge Pauper Lunatic Asylum,
George William Lawrence, Esq., M.D., Medical Superin-
tendent.

The committee of visitors in their annual report remark that the
sewage of the asylum having been used on the land, good crops
have resulted, not only of cereals, but of roots. The committee
also report that they have terminated their contract with the Cam-
bridge University and Town Waterworks Company, owing to the
company wishing to charge them £146 per annum, this being at
the rate of about 9^. 9rf. per head per annum on 300 patients.
For about £320 they have sunk a well and built a steam-engine
and engine-house, and propose to work the engine at an estimated
cost of £40 per annum.

The lady who has been matron of the asylum since 1858 having
retired, the wife of the clerk and steward was appointed in her
stead. We cannot avoid protesting against such an appointment,
as being, to say the least, ill judged, and, if not tending to weaken
the authority of the medical superintendent, manifestly fraught with
trouble for him in the future. It was a decided departure from the
policy that has of late been pursued in most county asylums. This
asylum, although containing nearly 300 patients, has no assistant
medical officer. We cannot conceive how the committee of visitors
reconcile themselves to the belief that they are doing their duty to
the 300 patients under their charge as long as they neglect to fill up
such an office.

We regret much to find, from the report of the committee, that
Dr. Lawrence has been ill, and has required a lengthened absence;
but we trust that his health will be soon permanently re-established.

In remarking on the deaths during the year. Dr. Lawrence con-
gratulates himself and the visitors on the fact that there has been
no death from epilepsy at night by suffocation. This he attributes
to an epileptic pillow, which he has invented. It has been in use
for three years, during which time no death from suffocation has
occurred.

Dr. Lawrence relates a curious accident ; it was in this wise :

" A boy, whilst gathering watercresses, twisted his left leg under him, and
hurt his knee-joint. He was able to get back to the asylum with difficulty
and was placed in bed. There was much pain and swelling for some days,
at the end of which time there was discovered in his knee-jomt a small hard
substance, circular and capable of but slight movement, which I thought to

1867.] Jieviews. 857

be a piece of detached bone, broken off by muscular action, or by the strain
on the ligaments at the time of the accident. He lay several weeks with the
leg in splints, but without recovering the use of the knee. The case was
one of doubt, many of the surgeons who saw it thinking it a case of loose
cartilage. As the boy was a narmless imbecile and much improved, we
applied for his admission to the Cambridge Hospital, and he was discharged
on trial. The case was operated upon by Dr. Humphry with very great
skill, and the foreign body proved to be a piece of detached bone with
articular cartilage on one side. The case has now gone on without a bad
symptom, and the boy will shortlj return to the asylum. Dr. Humphry
considers the case unique."

Second Annual Report of the Committee of Fisitors of tie Joint
Counties Asylum, Carmarthen. Francis Wilton, Esq., Me-
dical Superintendent.

This new asylum for the counties of Carmarthen, Cardigan, and
Pembroke, contained, on the last day of the year, 60 males and 39
females, in all 99 patients. The medical superintendent reports that
in the early part of August several patients were attacked with
choleraic diarrhoea, from which three died.

The asylum has not been opened for the reception of patients
very many months ; but Mr. Wilton has already introduced recrea-
tion of all kinds; and croquet, dropball, football, quoiting, and
cricket, have been the out-door games ; whilst battledore and shut-
tlecock, bowls, cards, bagatelle, draughts, &c., have formed the
principal in-door amusements. Moreover, the Commissioners report
most favorably on the asylum, which has not been opened without
great and many difficulties.

TheJReport of the Committee of Visitors, Superintendent, and Chaplain,
of the Cheshire Lunatic Asylum, Heney Lewis Harper, M.D.,
Medical Superintendent.

This asylum contained, on the 31st December, 238 males and 243
females, in all 481 ; and the committee "feel gratified in being able
to report that under the superintendency of Dr. Harper,'^ who has
recently succeeded Dr. Brushfield, " the affairs of the asylum have
been conducted in a satisfactory manner.'^ The asylum is quite
full, and the numbers are increasing at the rate of 40 per annum ;
therefore appUcation was made to the guardians of all the unions in
the county to know whether they could receive certain of the
lunatics into their unions, under the section in the recent Act of
Parliament ; but in no case was there the requisite accommodation,
consequently the committee are about to enlarge the asylum.

Dr. Harper remarks, in his report, that one patient, a man, on

358 Reviews. [Oct.,

admission, was found to have several bruises on various parts of his
body, and shortly afterwards was discovered to be suffering from
fractured ribs, evidently the result of violence previous to his
admission into the asylum. Dr. Harper may congratulate himself
that this injury was detected immediately on admission , and shows
how wise was the recent recommendation of the Commissioners in
Lunacy, that each patient should be minutely examined by a
responsible person, directly on admission into an asylum.

Fifth Annual Report of the Cuwherland and Westmoreland Lunatic
Asylum. T. S. Clouston, Esq., M.D., Medical Superintendent.

This asylum contained at the end of last year 278 patients, viz.
159 males and 119 females; and the committee report that the state
and condition of the asylum is most satisfactory ; that a new west
wing having been completed, the whole of the lunatics chargeable
to the two counties, for whom it was necessary to provide accom-
modation, and who were in a fit state to be removed, have been now
brought to Garlands, and there is still room to receive forty-six ad-
ditional patients there. This new block contains accommodation
for 100 women, and Dr. Clouston thus writes of it :

" It is," he says, "a narrow building, with plenty of windows and no corridors,
and therefore the rooms are light and airy. Every room in it has a through
ventilation, both by means of the windows, and ventilators near the roof and
floor that can be opened or shut, so that it is thoroughly well ventilated,
without, I hope, being too cold. In the evening, when the gas is lighted,
ventilation is provided for by openings above each gas-burner in the ceiling,
80 that the bad air from the gas is carried away, and a constant upward
current created. There is no other system of ventilation, and no system of
heating but by open fireplaces. The water closets, bath rooms, and
lavatories, are all placed in a special offshoot connected with the main
building by a narrow neck with windows on both sides of it, so that any
smells are cut off from entering the day rooms or sleeping rooms by a cross
current of air. All the sleeping accommodation is in the form of associated
dormitories, except six single rooms to which noisy patients maybe removed.

"The infirmary for twenty patients will be a great advantage to the
institution. All the furniture except the chairs has been made here. In
that way its strength and soundness is secured. All the linen has been
made up by the women, and the mattresses were made on the premises.
In this way, doubtless, some saving of cost has been effected, but, what is of
more importance, sound, durable articles have been got without any trouble
with contractors."

It will be in the memory of most our readers that in former
numbers the difficulties experienced at the Cumberland and West-
moreland Asylum respecting the utilisation of the sewerage and the
severe epidemic of dysentery from which the inmates suffered were
detailed and discussed. The following may be added as an
appendix :

1867.] Reviews. 359

"The general health of the patients has been on tlie whole very good.
The only exceptions were two or three slight outbreaks of diarrhoea among
a few of the patients, accompanied in two or three cases by dysenteric
symptoms. The cause, I have no doubt, was sewage emanations. McDougalPs
system of deodorization of the sewage by carbolic acid I cannot pronounce
a complete success. It is true it was subjected to perhaps too severe a test.
The sewage was run on to undrained land with a clay subsoil. It could not
percolate down through the soil, and however completely the sewage was
deodorized at first, yet it will necessarily decompose and give off injurious
gases, except the soil absorbs and transforms it. I never could detect any
offensive smell from the sewage when first run on to the land, but since it
has been run off in a covered drain we have had no more diarrhoea. The
field over which it is to run is not yet levelled and drained, and until that is
done we shall try no more experiments with it.''

This matter of the utilisation of the sewage is one of such great
importance, that we feel no apology is necessary for again de<;laring
how different is the experience at Hayward^s Heath to that of Dr.
Clouston. There the whole sewage from the asylum has been run
on to the land directly in front of the asylum for the last seven
years, and without the slightest ill effects ; and latterly it has been
run directly from the drains on to the land, without the intervention
of any tanks to collect the soKd matter. The soil is the stiff
Wealden clay. The fields are all well drained, and the sewage is
deodorised with tarholic acid and lime.

Mghteenth Annual Report of the North Wales County Lunatic
Asyluniy Denbigh. George Turner Jones, L.E.C.P. Edin.,
Medical Superintendent.

At the time the report was written there were in this asylum 372
patients — 183 males and 189 females. The institution seems to
have been fortunate in donations this year, having received a large
store of valuable prints, the gift of Messrs. Colnaghi, Messrs.
Graves, and Messrs. Hogarth; but, more valuable still, Mrs.
Mesham, a lady residing in the neighbourhood of the asylum, has
presented fourteen acres of freehold land, in perpetuity, for the
uses of the institution. The other matters in this report are of but
local interest.

Twenty 'first Annual Report of the Devon Lunatic Asylum. G.
Symes Saunders, Esq., M.B. Lond., Medical Superintendent.

There are 254 males and 289 females, making a total of 643,
now in the asylum at Exminster. These numhers include the
patients chargeahle to the borough of Plymouth, who have been
m this asylum since its opening ; and a contract has been entered
into to retain them for a further term of ten years.

860 Reviews. [Oct.,

This asylum was visited by the terrible scourge of cholera daring
last autumn. We can fancy nothing more dreadful than cholera in
a lunatic asylum, or more wearying than the anxiety it must cause
to all the officials — peril encountered and duty manfully done how-
ever, nothing can be sweeter than to know that our efforts are
appreciated, and the following paragraph from the report of the
committee must have been extremely pleasing to Dr. Saunders,
Mr. Stuckey, and the other officials. Speaking of the epidemic,
they write — " Before concluding this part of our report, it is our
duty to state that in our opinion the fullest care and attention was
bestowed on the sick, and that the exertions of the attendants, by
night and day, were unremitting. At the same time we have every
reason to think that all that could be done by medical skill and
treatment was effected by the medical superintendent. Dr. Saunders,
and by the medical assistant, Mr. Stuckey .^^

Dr. Saunders reports that the health of the patients had been
good during the summer, and up to the date of the outbreak there
had been a comparative immunity from diarrhoea, although cholera
and choleraic diarrhoea prevailed in the adjoining districts. On the
28th September two idiots, brothers, who had been in the asylum
nearly twenty years, were attacked with cholera in its most virulent
form. How the disease was imported, or in what way these patients
first came in contact with the germ of the cholera poison, is unknown,
although, writes Dr. Saunders, " the greatest care has been taken
to clear up the mystery on this point.^'

The disease rapidly spread, and patients were attacked in nearly
every ward on the males^ side. They numbered in all forty-five
cases, of whom thirty died; and thus by the 9th of November, when
the last case occurred, the disease, which confined itself to the males'
side of the house, had, as Dr. Saunders points out, more than
decimated the male population in the short period of six weeks. No
female patient, no male engaged in out-door pursuits, and no
attendant, was attacked, the disease confining itself almost entirely
to idiots, general paralytics, and dements. Dr. Saunders accounts
for the immunity of the females to the fact that the latrines for either
sex in the Exminster asylum are devoted to their exclusive and
separate use. Dr. Saunders gives the following summary of the
measures adopted to isolate, as far as possible, the infected patients,
and arrest the spread of the disease among the healthy.

**1. An observation room was set apart for the reception of all patients
attacked with diarrhcea and suspected cases.

**2. Two dormitories at the detached male new house were converted
into a cholera ward. A temporary staircase, external to the building, was
erected, and internal communication with other parts of the building was
cut off by a partition. All cases of decided cholera were at once sent to
this ward.

1867.] Reviews. 361

" 3. All closets and utensils were thoroughly disinfected, and cleansed
^ twice a day, oftener if necessary.

" 4. All excreta, vomit, as ^ell as dejections, were received into vessels
containing chloride of lime, carbolate of lime, or Sir W. Burnett's fluid.
When passed on the floor they were at once covered with disinfectants, and
removed without delay. A deep trench was dug in which the excreta were
buried.

'* 5. The attendants were directed to watch the patients narrowly, and
report to the superintendent, or assistant medical officer, any patient seen
going to the closet more than once a day, also to report the first symptoms
of diarrhoea or vomiting.

*' 6. All linen or mattresses tainted with the discharge to be burnt.

*' 7. The hands of all attendants on the sick to be scrupulously cleaned,
whenever they have become soiled by * rice water,' by washing in * Condy's
fluid.'

" 8. Special attention to be directed to. the feeding and clothing of all the
patients.

" 9. An extra allowance of meat was ordered for every patient in the
asylum, and other extras according to circumstances.

** 10. Convalescents to be kept some time separate from the healthy
patients.

** 11. The friends of patients were not allowed to visit the asylum.

'* 12. The patients in the ward where the disease first broke out were
removed to ]N o. 6 ward, and the patients in that ward were accommodated
in the chapel, which was fitted up as a dormitory containing thirty-six beds.
Every gallery, day room, and dormitory, with closets, &c., were thoroughly
whitewashed and disinfected throughout the asylum.

''13. A temporary cholera hospital for the women, according to a plan
submitted to the visitors by the superintendent, was erected. It consists of
a wooden building 60 by 20 ; 12 feet to the eaves, and 25 feet to the centre,
accommodating twenty patients, allowing to each patient 1000 cubic feet.
In design and construction it is similar to the military wooden hut or
hospital.

*' 14. A qualitative and quantitative analysis of the water was made by
Professor Voelcker, who reported that it was * unusually pure and whole-
some drinking water,' * and unusually pure as regards organic impurities.' "

TAe Annual Report of the Dorset County Lunatic Asylums^ Char-
minster and Forstan, for the Tear 1866. J. Gustavus Symes,
Medical Superintendent.

The two asylums at Charminster and Forstan continue to be
under the management of J. G. Symes, Esq., the senior medical
assistant, Mr. W. H. Clarke, residing at Forstan, and a second
assistant medical officer with Mr. Symes at Charminster, which is
the new asylum. The numbers in the two asylums on December
81st were— males, 237, females, 223 ; total, 460.

In the report of the committee we find the following : — "A new
set of general rules for the government of the two asylums has been
prepared/' A copy of these rules was forwarded to us with the
report, and we find that, although the senior assistant medical officer

362 Reviews. [Oct.,

is the oiily resident medical officer of the old asylum at Forstan, yet,
according to these rules, he is prohibited from visiting or entering
the females' wards after a certain hour in the evening, except in
company of the matron. This is a most unjust and wrong rule, and
that it should ever have been allowed to enter the book reflects, we
consider, very injuriously on the medical superintendent. How can
he expect to get good and efficient assistants with such a rule exist-
ing ? The only wonder is that medical men can be found willing to
submit to such authority. We hold that, in suffering such a rule to
pass, Mr. Symes has cast a most unjust and unnecessary slur on the
profession. He is obliged to own in his report that the present
senior assistant throws much assiduity into his duties, and trusts
each year wiU find him more able and willing in the service of the
county ; yet he does not consider him sufficiently trustworthy to be
allowed to enter the females' wards after a certain hour unless under
the wing of the matron.

Eighth Report of the Durham County Asylum. Bobert Smith,

Esq., M.D., Medical Superintendent.

215 males, 191 females, total 406, is the population of this
asylum. It is overcrowded, and plans for the permanent enlarge-
ment for 300 more patients are under the consideration of the Com-
missioners in Lunacy. In the mean time a temporary building,
principally of wood, at a cost of £468 11*. 5|tf?., to accommodate
seventy patients, is in the course of erection.

Writing on the deaths in his report, Dr. Smith relates the
following interesting case :

" One peculiar case, which presented all the symptoms of miliary fever,
deserves notice. A woman, under middle age, who had for several months
been an inmate of the asylum, and who was demented, was found one
morning to be in a high state of fever — pulse rapid and of moderate strength ;
respiration hurried and irregular; skm hard, dry, and hot; temperature
105 ; face somewhat dusky. Next morning she had profuse and offensive
perspiration and dejections. Towards evening acute pain and tenderness of
the joints supervened. Two days afterwards small patches of minute
pustules appeared on the surface of the joints, and gradually extended over
a considerable portion of the limbs. Shortly after the appearance of the

Eustules the tenderness of the joints disappeared, and the fever lessened,
ut more gradually. About seven days after, desquamation occurred ; and
the cuticle which came from the surface where the pustules were most
abundant presented a beautifully perforated appearance, the pustules still
remaining on the body after the desquamation had taken place, and it was
some time before all trace of these had disappeared. The patient gradually
improved in her mental condition, and was discharged a few months lufter-
wards, recovered."

1867.1 Reviews. 363

JSssew Imnatic Asylum, — Report of the Committee of Visitors, the
Medical Superintendent, and other Papers relating to the
Asylum, D. C. Campbell, Esq., M.D., Medical Superintendent.

This asylum contains 573 patients, of whom 250 are males and
323 females. Dr. Campbell, in his report, remarks, inter alia, that
in a number of the patients brought to the asylum a practice not
infrequent in cases of acute mania had been resorted to, viz.
bloodletting ; and he goes on to write —

" Throughout all ranks of society an opinion is pretty generally difHised
that insanity is a disease of a very inflammatory nature, and that strong
antiphlogistic means must be used to allay the excitement. Accordingly,
low diet, powerful purgatives, and bloodletting, are had recourse to, and it
frequently happens in those cases in which they are most detrimental. That
low diet in certain cases may be beneficial is not to be denied ; great dis-
cretion, however, even in this is required, for a furious state of excitement
may coincide with real debility, and may be best subdued by generous diet
— nay, even in some cases, stimulants may be required to secure repose. Of
all misapplied remedies, however, the worst is bloodletting, and jet in some
districts it is frequently resorted to. So strong is the impression that
insanity is of an inflammatory nature, that it often requires the authority of
an experienced practitioner to persuade the nearest relatives that bleeding
is unnecessary, if he cannot convince them that it is absolutely prejudicial.

" It is not, therefore, to be wondered at that some surgeons who are not
likely to see many cases of the disease should fall into the same error, and
by doing what they consider to be useful, or at all events innocuous, gratify
those around them. Surrounded with difficulties, struggling with the
patient, destitute of proper means of control, worried by friends, and over-
whelmed with suggestions, they perform what they deem a very simple
operation. Blood is extracted, the patient for the time becomes quiet, or
rather exhausted, and the surgeon congratulates himself, and is applauded
by the bystanders ; but in a very short time the scene is changed — the
patient becomes as furious or as incoherent as ever, and, if the plan be per-
severed in, soon sinks. Should, however, the want of success prove the
inutility of depletion, the unfortunate patient is then sent to an asylum, and
the medical officers have to contend, not only with the original malady, but
with an aggravation so well known in lunatic asylums that such cases are
looked upon as very doubtful, and in six cases out of ten, if the patient
survives, he sinks into a state of incurable dementia."

No less true are the following remarks, made by Dr. Campbell,
respecting the statistics annually presented with the reports of
lunatic asylums :

** The statistical tables," he writes, ** which I yearly lay before you contain
such abundant and various information as to make any general commentary
on the forms of disease admitted, the causes of the malady, or of the chances
of recovery aflbrded, unnecessary. These tables are compiled from the
records kept of each case, and, although every endeavour is made to obtain
information that may be relied upon, I can never present such tables to you
without stating the extreme difficulty of avoiding errors. In some cases I

864 Reviews, [Oct.,

regret to say that no dependence whatever can be pkced on the information
sent with a patient on admission, and in others no information can be
obtained. Tnese remarks especiallj apply to the returns made of the
duration and the causes of the malady."

Second Annual Report of the Glamorgan County Lunatic
Asi/lum, Bridgend. David Yellowlees, M.D., Medical
Superintendent.

This asylum contains — males, 156; females, 122; total, 278.
It was not opened more than two years ago, and the committee
report that the buildings are now completed ; several of the day
rooms have been papered and painted, and the whole house is be-
ginning to assume that air of comfort and cheerfulness which is so
necessary for the happiness and welfare of its inhabitants ; but it
appears to be rapidly filUng, and does not contain further room for
more than 31 males and 29 females. From Dr. Yellowlees' report
we learn that of the 41 patients discharged recovered only two have
been readmitted, and that only 5^ per cent, of the average numbers
resident have died, which is a very low per-centage of mortahty.
Curiously enough, the 13 patients who died were all males.

Dr. Yellowlees reiterates a truism which cannot be too often
repeated, that recovery in insanity is in an inverse ratio to the
length of the time of the disease previous to admission,, and he
shows that of the 140 admissions during the year, of 32 whose
disease dated back within six months of their admission 11 were
already discharged cured, and the remaining 29 appear to be
curable, whereas out of the remaining 68 only 8 are curable,

" It seems," writes Dr. Yellowlees, " to be a habit in some unions to send
a lunatic to the workhouse in the first instance, apparently, that the patient
may have a chance of getting over the attack without being sent to the
asylum. Such a course is greatly to be deprecated. The most important
time for treatment is lost, for, of course, the arrangements and attendance
of a workhouse make proper treatment impossible, however efficient its
officers may be. If the patient gets well soon, the union has been saved 8
little trouble and expense, at a great risk. K he does not speedily recover,
and yet does not become violent or destructive, be remains in the workhouse,
where it is but too likely that he will lapse into confirmed insanity, and will
be ultimately sent to the asylum on account of sudden excitement or dirty
habits, only when all hope of recovery is past. One such case, thus becoming
a life-long burden on the union, which early asylum treatment might have
averted, far outweighs the saving on those cases which recover without it, so
that on the ground of economy as well as of humanity the sooner an insane
pauper is sent to an asylum the better."

It may be remembered by some of our readers that we animad-
verted somewhat last year on the absence of beer from the dietary
of this asylum ; it is, therefore, but right to add this year that the

1867.] Reviews. 365

general health and condition of the patients has been excellent, and
that Dr. Yellowlees has seen no occasion to suggest any alteration
in the dietary.

Annual Report of the County Lunatic Asylum at JFotton, near
Gloucester. Ebenezeb. Toller, Esq., M.E.C.S, L.S.A.,
Medical Superintendent.

This asylum contained at the end of last year 595 patients, of
whom 283 were males and 313 females. Here, diflferently to the
experience in other asylums, the visiting justices are able to con-
gratulate themselves and the ratepayers generally on the fact that
the increase in limatics has not been so great for the last three years
as it was for some years previously.

The proportions of readmissions appear to have been exception-
ally large, " amounting to about a quarter of the whole number of
admissions.^' The committee, in their report, believe this to be
explained by the greater facility which has of late been afforded the
friends of patients to remove their relatives, who, although not
dangerous, were neither recovered nor hkely to improve materially.

The visitors have under their consideration the plan already
followed out in some other asylums, of having a small detached
block of building for the reception of patients in case of the out-
break of. an epidemic.

The asylum appears to be quite full, and plans for increased
accommodation will probably have ere long to be considered.

Report of the Committee of Visitors of the County Lunatic Asylum
for Hampshire. John Manley, Esq., M.D., Medical Superin-
tendent.

This asylum contained at the end of last year 618 patients, of
whom 283 were males and 335 females, being an increase of 26 as
compared with last year. In their last report the committee had to
regret the excessive mortality during the year, amoimting to the
very unusual number of about 16 per cent, on the daily average,
arising from causes then explained ; but during the last year the
deaths have been reduced to less than 12 per cent.

A flour mill, to be worked by the existing steam-engines, is about
to be erected, and will probably effect a material reduction in the
cost of flour.

This asylum is now quite full, and of the population of 618, 419
are chargeable to- unions, 10 to the county rates, 176 to boroughs
within the county, and 3 are private patients. The committee have

366 Ret^iews. [Oct.,

therefore been compelled to decide during the past year.whetherthey
shall enlarge the existing fabric or call upon the boroughs to provide
accommodation elsewhere for their patients. The committee have
decided — and it cannot be doubted wisely decided — on the latter
course, for to enlarge an asylum already containing upwards of 600
patients is a course oidy to be pursued from the direst necessity.

Dr. Manley complains very much of the imperfect orders, state-
ments, and certificates, on which patients were sent to the asylum,
more than 20 per cent, of the admission papers having to be returned
for emendation. He has therefore added as an appendix to this
report a statement of the details requisite to render an admission
paper valid, which might with advantage be copied into other
reports, for we fancy there are but few superintendents who have
not to make the same complaints, and in the appendix Dr. Manley
publishes there are such explicit instructions that the persons who
have to fill the certificates up cannot fail to do them correctly after
having read these instructions.

Kent County Lunatic Asylum^ Barming Heath, Maidstone — Twen-
tieth Annual Report. William P. Kirkman, Esq., M.D.,
Medical Superintendent.

Patients resident 1st January, 1867 — males, 303; females,
454; total, 757. 57 patients have been refused admission owing
to the overcrowded state of the asylum.

We congratulate the medical superintendent on having entered
upon the occupation of a newly erected residence, his old apart-
ments having been fitted up for female patients of a superior class.
Dr. Kirkman reports that attempts have been made, by the intro-
duction of earth closets, to utilise a portion of the asylum sewage,
but that they were not successful in preventing the exhalation of
offensive smells. This is different from the experience of these
closets in some asylums. They have been used for some years now
at the Northampton Asylum, and, if properly attended to, were
never found to be objectionable.

Report of the Committee of Visitors of the County Lunatic Asylum
at Lancaster. John Broadhurst, Esq., Medical Superin-
tendent.

Numbers in the asylum — 446 males and 450 females. The
weekly charge for the maintenance of patients in this asylum appears
to be unusually low, being only Is. Id. for the first three quarters
of the year, and 8«. 2d, for the last quarter, and suggests comparison

1867.] Reviews. 867

with other asjlmns, where the rate is higher, because it might be
inferred that, caieris paribus, economy is practised at the expense of
efficiency at the Lancaster Asylum, or else that the expenditure is
excessive in other establishments, where the rate is higher. Thus,
at the Sussex Asylum the rate is 9*. 9rf. weekly ; but on looking
through the accounts of the two asylums we tlnd that, whereas coals
at the Lancaster Asylum only cost 11*. 2rf. per ton, at the Sussex
Asylum they cost £1 3*. 6rf. — more than as much again. The
surgery and dispensary involved an outlay of only £44 18*. 4rf. at
the former asylum, containing 896 patients ; but at the latter it was
found necessary to spend as much as £107 7*. for only 550
patients. Again, there are two medical officers to each asylum, but
their salaries being distributed over so many more patients in the
one case than in the latter renders the average for each patient
much less in the larger asylum than in the smaUer.

The committee report that a new church for the asylum was
opened by Kcense from the bishop on the 4th instant. It has a
neat ecclesiastical appearance, and stands well on elevated ground in
front of the asylum. Access to it is obtained by the male patients
on the western side, and by the females on the eastern. The
church is capable of containing with comfort about 730 patients,
at a cost of about £3200. On the opening day there were about
500 patients present, and nothing could surpass their attention and
orderly conduct, we are told.

The death average in this asylum has been unusually low this
year, being only 7*23 per cent, on the number under treatment.
Mr. Broadhurst mentions in his report that " the recoveries have
been nearly 30 per cent, on the admissions, a higher proportion than
is usually attained.'^ We do not know whether Mr. Broadhurst
would here refer to the per-centage usually attained in his own
asylum or in asylums generally ; if the latter, he is somewhat in
error, as many asylums show a much higher per-centage than 30
per cent, on the admissions.

Report of the Committee of Visitors of the County Lmuitic Asylum
at Prestwieh. J. Holland, Esq., Medical Superintendent.

This asylum contains 497 males, 492 females, and has accom-
modation for 500 of each sex.

The following paragraph, from the report of the committee, is
noteworthy : — " On the appHcation of a Roman Catholic priest, who
attends gratuitously at the asylum, a suitable room has been pro-
vided for the celebration of Divine service according to the rites of
the Church of Bome, amongst the patients of that persuasion, the

368 Reviewa, [Oct.,

arrangements being under and subject to the directions of the
superintendent/^

A hospital for infectious and contagious diseases is being built for
the accommodation of fifty patients, in a most picturesque part of
the grounds, and is fast approaching completion.

Report of the County Lunatic Asylum at RainhilL T. L. Bogebs,

Esq., M.D., Medical Superintendent.

Numbers in the asylum — males, 303 ; females, 356 ; total, 659.
Dr. Rogers continues to find good results accrue from the practice
he pursues of allowing patients to go out on visits to their friends,
paying them, at the same time, a weekly allowance. In his last
report Dr. Eogers had to remark upon the very bad condition of
many of the women patients, as regarded their destructiveness,
violence, &c., owing to their being drawn from the Irish quarters
of Liverpool ; but he anticipated that this unsatisfactory condition
would be but temporary, hoping by increased discipline, more
amusements, greater comforts in the wards, and an augmentation
in the numbers and pay of the attendants, to work improvement.
These hopes have to a great extent been fulfilled.

Leicestershire and Rutland Lunatic Asylum, The Eighteenth Annual
Report of the United Committee of Visitors. John Buck, Esq.,
Medical Superintendent.

This asylum contained at the end of last year just 400 patients;
of these, 159 males and 182 females were pauper patients, 11 males
and 1 female criminals, and 22 males and 25 females private
patients.

There is no report from the medical superintendent, and the
report from the committee is almost entirely taken up with their
reasons for refusing to comply with the very reasonable request of
the Commissioners in Lunacy, often reiterated, that an assistant
medical officer be appointed. Their objections to filling up such an
office are really too puerile to merit attention.

The Fourteenth Annual Report of the Lincolnshire County Lunatic
Asylum at Bracebridge, near Lincoln. Edward Palmeb,
Esq., M.D., Medical Superintendent.

This asylum contained at the end of last year 521 patients, of
whom 241 were males and 280 females.

1867.] Beviews. ^ 369

" Further experience," writes Dr. Palmer, " confirins the usefulness of the ,
probationary discharge, for a month or more, of patients whose convalescence
IS tardy^— whp arrive at a certain point in their progress towards recovery,
and there remain in a condition of mind which can neither be regarded as
quite sound, nor yet so obviously unsound as to make the necessity of their
continued detention clear. In some doubtful cases, it has enabled the
superintendent to test, as it were, the strength of his work ; in others, by
satisfying the home-affections, and thus bringing to bear an element of
treatment which the asylum is neither able to provide nor supersede,
complete recovery has been established. Ten cases were thus sent out
during the year, all of which went on well at their homes, and were subse-
quently fully discharged. The superintendent contemplates extending this
principle to chronic cases by allowmg them to visit their friends occasionally
for short periods, due precaution being taken for their proper care and sare
return to the asylum. He has, indeed, frequently permitted patients coming
from the neighbourhood to spend the day at their homes, leaving the asylum
in the morning and returning in the evening, and has always been pleased
with the results. To carry this practice out with patients from more distant
parts of the county, and who would, consequently, be unable to come back
again on the same day, the formal sanction of two of the visitors will be
necessary."

The Commissioners in Lunacy, in their late visits to the county
asylums, have much pressed upon the authorities the importance of
each patient being carefully examined immediately on admission;
and, to ensure a systematic observance of this very necessary pre-
caution. Dr. Palmer has had a blank form printed showing, in an
interrogative manner, all the observations required to be made. A
copy of this is given to the head attendant to fill up, sign, and
return immediately after the admission of each patient.

Eeviewing the improvements of the past year. Dr. Palmer thus
writes of the amusements of the patients :

" The amusements of the patients were very materially enhanced by the
introduction of more field sports and athletic exercises, which were 'most
successfully organised and carried out by Dr. Douglas. They consisted of

r)it8, foot-races, the long and high jumps, sack-races, putting the ball,
owing the -hammer, Aunt-Sally, the ball-target, &c., and, after affording
excellent and healthful diversion through the fine months, were concluded'
in the autumn by a keen contest for prizes. It was a gala day. Upwards
of three hundred patients of both sexes were present, all of whom, either as
competitors or spectators, took the liveliest interest in the proceedings. In
the evening the prizes were ceremoniously distributed, and refreshments, a
dance, and the ascent of a fire-balloon closed a day of real enjoyment to the
patients."

The Sixteenth Annual Report of the Committee of Visitors of the
County Lunatic Asylum at Colmey Hatch. Edgar Sheppard,
Esq., M.D., Medical Superintendent, Male Department ; W. G.
Marshall, Esq., Medical Superintendent, Eemale Department.

This asylum, still increasing in size, now contains 826 male
patients and 1210 females, making a total of 2036.

VOL. XIIT. ^^

370 Revieics. [Oct.,

We find, from the report of the Committee of Visitors, that "the
Turkish bath continues to be a valuable auxiliary to the medical

superintendents in their treatment of the patients The

question of providing increased means of bathing the patients has
engaged the attention of the Committee *" and they have adopted a
plan for providing bathing accommodation in a separate building, at
an estimated cost of £1300 for the female patients of cleanly
habits.

The following, also, is worthy of note as a decided improvement :

"The Roman Catholic Ministers belonging to St. Joseph's Retreat, at
Uighgate, having requested the committee to allow them to have the use of
some room in the asylum in which the patients of the Roman Catholic
persuasion might be assembled occasionally for religious service, and there
being a large number of patients of that church in the asylum, the committee
granted the use of the female visiting-room for this purpose on any Wed-
nesday or Friday."

Many pages of the report are taken up with the correspondence
which took place between the Commissioners in Lunacy, the Com-
mittee of Visitors, and Dr. Sheppard, respecting the treatment of
certain of the male patients of destructive habits ; but this subject
having been already referred to in the pages of this Journal, it is
unnecessary again to allude to it.

In the report of the Commissioners in Lunacy on this asylum we
find the following paragraph :

*' In lieu of ' Case-book/ certain forms screwed together into a
loose back have been recently adopted. This plan may possess some
advantages ; but it must evidently tend to increase the labours of the
medical officers, who at this asylum are, in our opinion, abeady
overtasked.^'

This opinion experience enables us to question. We have tried the
plan very extensively, and found it to save much trouble, and, at
the same time, tend very materially to increased accuracy in keeping
the cases — a duty often seriously neglected, for instead of filling up
the cases from memory after the medical visit, in the ordinary case-
book, the loose sheets, one to each patient, are kept in each ward ;
and any remarks that are necessary are made at once and on the
spot, with the patient before you.

The admissions have not been quite so numerous as in some
former years, owing to the asylum having been closed for some
weeks to fresh admissions during the epidemic of cholera in
London.

Dr. Sheppard writes in his report :

" We endeavour day by day, and little by little, to render the wards more
cheerful and habitable, by various additions and embellishments, and by
encouraging kindness and sociability on the part of the attendants towards
those under their immediate care.

1867.] Reviews. 371

''The amusements whicli take place in the two large halls are also as
yarieJ as we can make them. The sood which they do, the interest which
they arouse, and the cheerfulness which they engender, are of inestimable
value. The trouble which they involve to those who have the management
and direction of them is more than compensated for by the appreciation
which they receive from the patients themselves."

Mr. Marshall reports that another year's experience in drafting
patients from the main building to the Convalescent Home pre-
paratory to their friends on probation has proved most beneficial.

The following also is interesting :

*' The Turkish bath erected in this institution some time since, has been
during the past year regularl]^ used for female patients with very good effect.
It is proved to be very efficacious in cases of melancholia and dementia ; and
in one case of dementia after puerperal mania, the patient attributed her
recovery to this remedial agent. Previous to her having the baths she
suffered from small abscesses of a furuncular character, which she prevented
healing by constantly picking, and she would sit listlessly about the ward,
not tiding any interest in objects around her. After the third bath her
habits became much improved, her health re-established, and she began to
employ herself in needlework and general household work, and was a most
useful patient during the remainder of the time that she resided in the
asylum.

The Twenty- first Report of the Committee of Visitors of the County
Lunatic Asylum at HanwelL W. C. Beglby, Esq. M.D.,
Medical Superintendent, Male Department ; J. Murray Lindsay,
Esq., M.D., Medical Superintendent, Female Department.

On 31st December, 1866, the total numbers in this asylum were,
1723, viz. 645 males and 1078 females. A case of typhoid fever
having occurred during the past year on the females^ side of the
house, the committee have become alive to the danger likely to accrue
from an epidemic of an infectious disease in this large and crowded
establishment, and are about to recommend that a detached hospital
should be built. The asylum is much crowded, and admission has
been refused to a large number of paralysed and epileptic cases.

The report of the Commissioners in Lunacy is more favorable
than it has been on some previous occasions ; but they terminate it
with a complaint that no one can deny the justice of. Thus they
write :

" It is a matter of much regret to us to find that, notwithstanding the
large increase in the number of the patients since the last visit, there are
BtilT only four medical officers, the temporary addition made during the
months of holiday enjoyed by these officers respectively during the past
summer have since been withdrawn. Speaking from a large and varied
experience, we say, without any kind of doubt, that with only such a staff,
1750 patients cannot be under proper supervision. Able and efficient as
the present officers are, all the work required of them cannot be done, and,

372 Reviews. [Oct.,

in circumstances of creat difficulty, Dr. Begle^ and Dr. Lindsay ap^ar to
us to have acquitted themselves as to be entitled to the further assistance
which will enable them more completely to discharge their arduous duties."

The report of the Farm Committee contains some interesting
particulars respecting the utilisation of the sewage; we make,
therefore, no apology for publishing it in extenso.

•* During the past year much has been done for the more advantageous
utilisation of the sewage, especially in the Old Field. At the commencement
of the year the path on the west side by the men's front airing grounds was
raised fifteen inches. The land was dug and laid on a hanging level, so that
the sewage could run down freely from the hydrants on the top of Old Field,
a channel was cut about the middle of the top part of Old Field to receive
the sewage from the above-named hydrants to irrigate a piece of land
adjoining', which has been laid down with permanent grass, which, with the
Italian rye-grass on the lower part of the Old Field and the Brent Meadow,
is sufficient to take all the sewage.

" The four acres of permanent grass laid down in March last has pro-
duced—

"Ist cut (to strengthen bottom) 8 tons per acre.

2nd,, 16

Srd „ 16

40 tons per acre.
Value, 160 tons at 20*. per ton, £160.

" The four- and- a-half acres of Italian rye grass of two years* standing has
produced —

"Ist cut 16 tons per acre.

2nd „ 12 „

3rd „ 8 „

4th „ 6

42 tons per acre.
Value, 210 tons at 1«5*. per acre, £152 10*.

'*And one acre of Italian rye-grass, of three years' standing has pro-
duced—

** Ist cut 8 tons per acre.

> 2nd,, 12

3rd „ 8

28 tons per acre.
Value, 28 tons at 15*. per ton, £21.

''The effects of sewage is marvellous, and it seems to suit all kind of crops,
our cabbage, particularly, have been extraordinary, very many have been
cut weighing upwards of 25 lbs. each, and the average weight may be fairly
taken at 20 lbs. each, and the growth is so rapid that we have been compelled
to send them to market, not being able to use them fast enough. The
savoys, parsnips, turnips, onions, leeks, and celery have been equally
benefited and much improved by the free supply of sewage ; in fact, there
appears to be no crop which it will not suit and to which it cannot be safely
and advantageously applied."

From Dr. Lindsay^s report we learn that 143 females have been
refused admission during the past year, owing to the want of roo;n,
" the existing regulations restricting the admissions, after a certain

1867.] Reviews. 373

point is reached^ to recent and curable cases^ and such as are not
complicated with paralysis or epilepsy-— twelve beds being reserved,
for this purpose/^ This may partly account for a paragraph in the
Commissioner' report, which must notwithstanding have been very
gratifying to Dr. Lindsay. We refer to the following : *' Generally
throughout the female division the patients were singularly free
from excitement, and in their demeanour quiet and orderly .'*

There is a lengthy report, as usual, from the matron, which is
remarkable neither for the elegance of its diction nor for its respect
for the Queen's English, as the following specimen, selected from
others, will demonstrate :

" The fres ordered by the Committee on the occasion of one of
their visits in the early part of the year, to be made daily in the
dormitories of the Western Tower Basement has been resumed, and
are continued with increased comfort to the patients.^'

In another place she writes, *' I am happy to say that, in only
one instance has there been cause to reduce a nurse from ineffi-
ciency.'' How bad must her teaching have been to reduce a nurse
from inejlciency to something worse, which is left to the imagi-
nation of the reader.

The Fourteenth Annual Report of the Committee of Visitors of the
Joint Lunatic Asylum at Abergavenny, for the Counties of Mon^
mouth, Hereford, Brecon f Radnor, and City of Hereford. D. M.
M'CuLLOUGH, Esq., M.D., Medical Superintendent.

Number in the asylum, males 205, females 251, total 456 ; which
is quite as many as it is capable of containing. Dr. M'CuUough in
his report mentions that the very large number of 21 patients out
of the 91 males were labouring under general paralysis. This has
necessarily added to the mortality, and also much increased the
number of helpless and incurable patients in the asylum.

" I express no opinion," writes Dr. M'Cullou^h, ** as to whether an asylum
for the insane is the proper place for such weak-minded helpless paralytics
as 1 have mentioned. No cases require more careful nursing, and none'
make heavier demands on their attendants and on the resources of a well
organised establishment ; and in none are the results of neglect more de-
plorable. Such nursing should be provided somewhere. I wish merely to
call attention to a change which 1 believe is taking place in the class of
patients sent to Asylums.

*614i Ee views.. [Oct,

Report of the Northampton General Lunatic Asylum for 1866.
J. Bayley, Esq., Medical Superintendent.

This asylum contained on the last day of last year 209 males and
206 females, total 415.

From the report of the Committee of Management we learn that
the asylum enjoys a continuous improvement and prosperity, both in
its medical and material aspects ; that there is now ample room for
the reception of all the county and borough patients ; that spade
husbandry has been introduced on the farm, together with other out-
door work, with the satisfactory result of raising the number of patients
thus employed from thirty-two in former years to sixty-two during
the past year, whilst the number of those employed in other ways
has not been allowed to decrease ; that the accommodation for the
private patients has been much improved, and further improvements
are still being made in the apartments occupied by the gentlemen.
When they are completed a greater number of that class can be
received. A detached residence is being provided for the medical
superintendent. All this demonstrates that the Northampton
Asylum, although now an old establishment, is determined not to
lag behind in the march of improvement.

In Mr. Bayle)'s report we find the following exceptional case
recorded :

'* Seclusion has been seldom required ; but restraint has been used once.
In this case, owing to the extreme violence of the patient, both to herself
and others, it was a choice of two evils, either to keep her constantly in a
single room, and to have a severe struggle with her whenever it was
necessary to go near her, or to use restraint by fixing her hands to her
sides, by means of strings attached to her sleeves at the wrists. Since this
has been done, she has been allowed to associate with the other patients in
the wards, and to take walking exercise both in and beyond the grounds. I
am strongly opposed to restraint in any form, but 1 feel satisfied that in
this case it was the best course that could be adopted. The patient had
been sent here from another asylum, where she was (juite unmanageable,
and when admitted she was extremely weak and emaciated. Now, chiefly
owing to the exercise she is enabled to take, she is improving in health and
condition.

** I regret that I cannot speak favourably of the general health of the
patients during the past year. Diarrhoea and typhoid fever have prevailed,
the former to a severe extent throughout the spring and autumn ; smallpox
also broke out on the female side of the bouse m the early part of the year.
All the patients who were affected with it were removed to the hospital on
the farm as soon as the disease showed itself, and every means were adopted
to prevent its spreading through the house; these, I am happy to sayt
proved effectual."

1867.] Iteviews. 375

Litilemore Asylum, Superintendenfs Beport for 1866, with
Statistical Tables. William Ley, Esq., Medical Super-
intendent.

The number of patients now chargeable to the visitors of the
Littlemore Asylum are 278 males, and 337 females, of whom 228
males and 282 females remain there, the rest being distributed in
the Bucks, Worcester, and Dorset Asylums. 156 patients were
admitted during the past year, being the largest number ever
admitted in one year since the year of opening. It will thus be
seen that this asylum is quite inadequate at present for the require-
ments made upon it, and Mr. Ley^s report is almost entirely taken
up with the consideration of this question. This inconvenience is,
however, but temporary j for when the new asylum for Berkshire is
completed, and the existing partnership at Littlemore between the
counties of Oxford and Berks dissolved, there will be ample room
for the Oxfordshire patients at Littlemore. The progress made
towards this desired end seems from Mr. Ley^s report to be but
slow, for he writes :

" The proposed new asylum for the county of Berks is as yet far
from being in an advanced position, and the period at which it will
afford its reUef to Littlemore is more distant. The advance of the
arrangements for providing the Berkshire Asylum is, however, so
positive, that the certainty of it receiving a large number of the
patients now at Littlemore may be calculated on as a known resource
in prospect.^

Twenty -second Annual Report of the Medical Superintendent of the
Lunatic Asylum for the Counties of Salop and Montgomery, and
for the Borough of WenlocL H. Rookb Ley, Esq., Medical
Superintendent.

This asylum contains 447 patients, of whom 201 are males and
246 females, and additions have lately been effected by which as many
as 510 patients can be accommodated.

Mr. Ley, in his report, writes thus :

" The general principles of treatment followed in the asylum are those
sanctioned by experience as being the most conducive to the welfare of the
patients, and the economic management of the institution. Systematic and
well regulated occupation being one of the best remedial agents in the
treatment of insanity, every effort has been made to find some suitable em-
ployment for those who are willing and able to work, and as some evidence
of the system of industry that prevails in the house, I beg to refer you to

376 Reviews. [Oct.,

Table 22, which gives the average daily number employed during the year.
In addition to those therein enumerated, there are many others who, being
unfitted by the state of their health, or their previous habits of life from
continuous employment, have found some desultor]^ occupation in minor
ward duties, in the office, in copying music, &c. ; iu fact all who evinced the
least capability, and whose health would permit, have been taught some
pursuit, either joinering, tailoring, shoemaking, mat or mattress making,
and amongst those so instructed we have now several efficient workmen.
The necessary repairs and other requirements of the building have been
promptly attended to, and for the most part accomplished by the labour of
the patients. The various shops have continued in successful operation.
In addition to the mending — no small item in a household of nearly 500—
all the clothing required by attendants and patients, and all the articles
necessary for domestic use, have been made on the premises. The most
beneficial kind of labour, however, to the patients, and perhaps the most
remunerative to the asylum, is out-door employment in the roads, airing
courts, garden and farm ; much labour has been expended upon the latter.
Some additional piggeries have been built by the patients, the farm buildings
have been kept in good repair, and, although the profit from the farm has
not been very great, the land has been considerably enriched during the
autumn by a more extended system of sewage irrigation ; and I hope will in
future be correspondingly more productive.

" While advocating the value of well regulated occupation as a remedial
agent, I have not been unmindful of its very important auxiliary amusement.
In addition to the balls twice a week, we have had a succession of concerts,
glees, readings, and exhibition of magic lantern."

Nineteenth Annual Report of the Somerset County Pauper Lunatic
Asylum. Egbert Boyd, Esq., M.D., P.E.C.P., Medical
Superintendent.

Patients remaining in this asylum on the 31st December, 1867,
males, 216; females, 271: total, 487. The report of the Com-
mittee of Visitors is very brief, the only fact of general interest
mentioned being that the salary of the assistant medical officer has
been increased from £120 to £150, a course worthy of imitation in
other asylums.

Dr. Boyd's report, as usual, stands prominently forward amongst
those of other superintendents, as being by far the most voluminous
and interesting. We are, however, somewhat surprised at his prO"
posing to reUeve the existing difficulty of providing accommodation
for the ever increasing number of lunatics in this country by
imitating the asylums of " Salpetriere^' and " Bicetre.^'

The following remarks, as coming from a physician of such wide
experience as Dr. Boyd, are interesting :

" M. Falret, physician to this large hospital of Salpetriere, in his work
recently published, states that after several years' research into the morbid
anatomy of insanity, and after failing to elucidate the nature of the malady,
by the aid of facts so gained, he next attempted to interpret the nature of
Rental disorders by recourse to the doctrines of psychology, especially those

1867.] fieviewi. 377

of the Scottish metapbyslcians for fifteen years, but at the end of that time
had to lament that his labour was all vanity and yexation of spirit. My
own experience of upwards of thirty year^, and after having examined nearly
every case that has aied in this institution, and previously upwards of two
thousand of the poor in the infirmary of St. Mary lebone, the results of which
have been published, agrees with that of M^ Falret as regards the morbid
anatomy of insanity, which may be considered, and is very frequently only
the delirium of chronic disease. The connection between mental disorder
and bodily disease has been frequently alluded to, and even so far back ag
in the first annual report of this asylum. In the analysis of the causes of
insanity of the first two thousand cases, in the 17th annual report, p. 28, it
is shown that about one half depended upon bodily or physical causes.
Therefore as the sick-ward of the union is the basis of all care for the sick
poor, and insanity is so frequently the result of bodily ailments, the laws
regarding medical relief and pauper lunacy should be amalgamated."

Dr. Boyd seems thoroughly to give in his adherence to the vexed
question of the propriety of amusements for the insane, and of the
eflfect of music on the insane he writes :

" For a belief in the wonderfully soothing efiects of music on the insane
we have the authority of Holy Writ, in the case of King Saul ; and the
Greeks and Romans were equally aware with the Jews of its power. In
modern times the efiect which the 'Kanz de Yaches' produced on the Swiss
and the * Reel of Tulloch gorum' on the Highlanders is well known. Music
is said by Esquirol to act upon the physical system by producing gentle
shocks upon the nerves, quickening the circulation. It acts upon uie mind
in fixing the attention by mild impressions, and in exciting the imagination
by agreeable recollections. It is a valuable remedial agent, particularly in
convalescence."

Dr. Boyd, still persevering, continues his investigations into the
treatment of epilepsy. His experience as to the efficacy of the
bromide of potassium seems to coincide with our own, for he writes :
-" In the case of the giri, mentioned in the last report, to whom
bromide of potassium was given, there was a cessation of fits, and
it was left off for some weeks ; the fits returned, but again ceased
after resuming the use of this drug.'^ He has also tried treatment
by hypodermic injection in violent mania, and narrates that one
female maniac, C. L., aged 35, single, most obscene in her conduct
and language, noisy, destructive, and dirty in her habits, got well
rapidly after the employment of the hypodermic injection of a solu-
tion containing half a grain of acetate of morphia. Several others
were quieted by similar means, procuring them sleep after the failure
of narcotics given in the usual way.

The statistics to this report are worked out in a very complete
manner, and the analysis of the tables in the appendix is replete with
information. The post-mortem examinations are continued and
recorded with the same exactness as has marked the labour in this
asylum for the last nineteen years, and the only subject for regret
on the part of the workers must be the barrenness so far of the
results obtained. Let us hope for better things in the future.

378 Reviews. [Octv

Sussex County Lunatic Asylum, Hay warts Heath — Highth Annual
Report. C. Lockhaet Eobeetson, Esq., M.D. Cantab.,
Medical Superintendent.

The number in this asylum on the 31st December, 1866, were —
males, 240 ; females, 303 : total, 543. Prom the report of the
Visitors we obtain the following :

"' At the Epiphany Sessions the court ordered that plans for increased
accommodation should be prepared and laid before the court. These were
accordingly submitted to the Secretary of State, and approved by him, and
at the Easter Sessions they were laid before the court and approved, The
cost of carrying these plans into execution will be about £9300. The
court granted a sum of £6500, and the committee of visitors will be enabled
to make up the deficiency from a balance at their disposal, arising from an
economical management of the asylum. Part of the plan sanctioned and
approved of by the Secretary of State and the Court of Quarter Sessions
was the purchase of two small houses in front of the asylum for the purpose
of bein^ altered and adapted for the reception of such infectious and conta-
gious diseases as may from time to time occur in the asylum. This pur-
chase has been completed, and, although fortunately the asylum is free from
all infectious and contagious complaint,* the premises will be extremely ser-
viceable at the present time for receiving a portion of the male patients
until the new ward is complete. The alterations necessary to be made in
these premises are trifling, and can be effected by the workmen belonging to
the asylum.

" The committee have every reason to believe that the alterations and
additions already sanctioned by the Court will be completed by the Easter
Session, and part of them will be completed and in use in six weeks, and
the whole will be completed within the estimate made by the committee.
They will be a most material and important addition to the asylum, which
will then accommodate about 700 patients, the original number accommo-
dated being 450."

These alterations include two large dining halls, one for each side
of the house, and each capable of dining 450 patients.

Twenty -ninth Annual Report of the Suffolk Lunatic Asylum, John
KiRKMAN, Esq., M.D., Medical Superintendent.

Population — 157 males, 205 females: total, 362. It must
have been a great relief to Dr. Kirkman to have been enabled to pen
the following lines :

^ "It has for so long been the custom to show the annual uniformity of
similar progress, that it is almost the gratification of variety to point to the
very unusual feature which must open the report of the past year. For
many years the almost invariable demand has been for additional room.
Though no county pauper has ever been refused, the admissions have been
such as to render several alterations compulsory, for the required accommo-
dation. These necessairy alterations have now been almost completed : and,

1867.] Sevieics. 379

as on former occasions, by home labour : and consequently at a cost very
much below what could have been otherwise incurred : and it is believed
that they have secured for the patients the advantages of a good asylum ;
they are extensive enough to meet present wants, and they have received
general commendation."

Further on in his report Dr. Kirkman writes :

" Several very interesting patients have been discharged during the last
year, with whom a regular correspondence is kept up. It has always been
a cause for thankfulness, that any efforts for the welfare of discharged
patients, has been acknowledged and appreciated by so many. We can
refer to many returned home, in whose hearts peace has found a resting-
place in the asylum, though their intellects were incapable of repose : and
there are many resident now, with whom it is imperative on prmciples of
Psychological treatment to dwell upon those indisputable truths on which
the weary mind may most securely rest, and the troubled heart be still.
All departures from sound reason do not verge into the type of the Gada-
rene demoniac, but all that were lunatic, as well as those that were taken
* with divers diseases,* all indiscriminately met with sympathy from the
multitude who brought them, and from the Great Physician who healed
them. Sympathy is never lost upon such patients as these, and when our
better afifections are called into exercise, they will not allow of our being
indifferent or unaffected spectators of their sorrows. * They thank us
much for what is said or done, but well wb know their thanks are for our
tears.' "

In the next number of this Journal we hope to be enabled to
consider the remaining English asylums, and also those we have
received from Scotland, Ireland, and America; therefore, if these
should meet the eyes of any superintendent who has not already
forwarded us his report, we shall be much indebted if he would at
once forward one to Dr. Robertson, at Hayward^s Heath.

S. W. D. W.

PART lll.-QUARTERLY REPORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.

Note. — TAe length of the Report of the Proceedings at the Anmml
Meeting compels us to omit the usual Quarterly Rejport on the
Progress of Psychological Medicine,

380 [Oct.,

PART IV.-NOTES AND NEWS.

Proceedings at the Annual General Meeting of the Medico-Psycho-
logical Associationy held at the Royal College of Physicians, on
Wednesday, Slst July, 1867, under the Presidency of Db.

L0CKHAB.T EOBERTSON.

AGENDA :
I. Meeting of the General Committee, at 11 a.m.

II. Morning Meeting of the Association, at 12 p.m.

1 . General Business of the Association.

2. The following gentlemen will be proposed as Honorary Mem-
bers of the Association : StafT-Surseon Baron Mundy, M.D., John D.
Cleaton, Esq., Ludwig Meyer, M.D.

in. Afternoon Meeting of the Association, at 2.30 p.m.

1 . Address by Loekhart Robertson, Jf.2)., President.

Papers will be read by —

Baron Mundy, M.D. — " A Comparative Examination of the

Laws of Lunacy in Europe.'*
John Q. Davey, M.D. — " On the Insane Poor in Middlesex,

and the Asylums at Hanwell and Colney Hatch."
Harrington Tuke, M.D. — ** On Monomania, and its Relation

to the Civil and Criminal Law."

The Council met at eleven a.m.

The Morning Meeting of the Association was held at twelve noon.

The following gentlemen were present :

Dr. Charles John Bucknill (Lord Chancellor's Visitor), Dr. Loekhart
Robertson, Dr. H. Tuke, Dr. Robert Stewart, Dr. Maudsley, Professor Lay-
cock, M.D., Mr. D. lies, Mr. Reed, Dr. Wood, Dr. Paul, the Baron Mundy,
M.D., Dr. Christie, Mr. G. Dodsworth, Mr. J. T. Dickson, Dr. Stewart,
Mr. Mould, Mr. Ley, Dr. C. H. Fox, Dr. Edonston, Dr. Sheppard, Dr.
Davey, Dr. Manley, Mr. Blake, M.P., I^t. Monro, Dr. Chapman, Dr. C. West-
phal. Dr. Brushfield, Dr. Belgrave, Dr. Williams, Dr. Eastwood, Dr. Sher-
lock, Dr. Hunt, Dr. Down, Dr. Haviland, Dr. J. E. Tyler, Dr. Blandford,
Dr. Murray Lindsay, Mr. Manning, Dr. Hart Vinen, Dr. Palmer, W. M.
Hollis, Esq., J.P., Dr. Glover, Rev. W. Macllwaine, Belfast, Dr. Tweedie,
Dr. John Robertson, Mr. Dunn, Mr. Davidson, Colonel Smith, Dr. Brewer,
J. Stuckey, Esq., Dr. P. Saunders, Dr. Blatherwich, Dr. Balfour Cock-
burn, Dr. Lorimer, Dr. Hoskins, Dr. Jackson, Dr. Stabb, Dr. Kempthorne,
Dr. Mickley, Dr. Edmund Lloyd, Dr. Gardiner, Dr. R. A. Bayford.

Dr. Tuke. — In the absence of Dr. Browne, our president, I propose that
our ex-president Dr. Wood take the chair.

1867.] Notes and News. 381

Dr, Christie. — I will second that, with pleasure.

The chair was then taken by Dr. Wm. Wood.

Dr. Wood. — Gentlemen, in the absence of our president, who is prevented,
nn fortunately, from being present with us to-day, it has been suggested that
I should resume my former post for a few moments, in order to explain the
circumstances under which we fell into an error, last summer, in electing
our president. We were not aware, at the time, what the rule was on the
subject, and it is right that we should, as far as we can, put ourselves
straight. The rule requires that the president should be elected by ballot,
but that rule was overlooked, and the consequence is, that the gentleman
whom we intended to be our president, is at the present moment only in*
formally so. It was therefore thought better, on our talking over the matter
in committee, that I should for the moment take the chair, and ask you to
be so kind as to remedy the defect, as far as it can be remedied, now. Ac-
cording to the strict rules for carrying through the election of president, I
propose that Dr. Robertson's name should be submitted to you, and that a
oallot should take place now. That will put us right, as far as it is possible
that we can put ourselves right, in regard to the error into which we fell
last year.

Dr. Manley. — ^I beg to second that proposition.

Dr. Davey. — If I may be permitted to make a few remarks in reference to
that matter, I beg to assure Dr. Robertson, and every gentleman present,
that the course I have taken in regard to this has been one based entirely
upon a principle of right, and a wish to adhere to the rules of the asso«
ciation. I could not for a moment entertain the slightest objection to the
nomination and appointment of Dr. Robertson, as the president of this
society, and it was not with that view that I took the steps which I have
taken. Those steps, I believe, are known to ^ou all, and I beg to assure
you that what I did was done upon a principle of duty, and quite irre-
spective of any personal feeling on the matter. 1 acted, as I believed, in the
cause, and in the interest of this society.

Dr. Monro.— As I was unfortunately in error last year, perhaps I may be
allowed to say a word with regard to that printed paper which has been sent
round to the association. I assure you that I was not under the slightest
impression that I was at all transgressing the by-laws of this institution
when I seconded Dr. Robertson's nomination. When I first looked at the
printed letter, I saw that it commenced with explaining that our secretary,
Dr. Tuke, had got into some great scrape, and I was not so much upset by
that as by immediately afterwards findm^ that I was, though completely
innocent myself, one of the chief accessories to the scrape. The motives
which actuated me for the moment in seconding Dr. Robertson's nomina^
tion where simply these : he had been an old friend of mine, and we had
a little argument and quarrel in this association in previous years, and I
thought it would be a capital opportunity to show my good feeling towards
him by seconding the proposal tnat was made, that he should be president of
the association. I also felt that, as we had had some of the (what I may call)
private-asylum members of the association in the chair, we ought to have
a change, and elect one of the county men, and I thought Dr. Robertson
was one of those who seemed to be well fitted for the post. I was there-'
fore glad to have the opportunity of seconding the nomination. I assure
you I had no intention whatever of offending against the by-laws, and was
unfortunately ignorant of the particular by-law which has been referred to.
1 must certainly repudiate the suggestion which has been put forward, and
I may say, that I entirely sympathise with the other side of the question.
I do not approve of the governing by cliques, and there was not any clique
on this occasion, I assure you.

382 Notes and News. [Oct.,

Dr. Tuke. — I will not detain you one moment, but merely widh to explain
that we bad a crowded meeting in Scotland. It was tbe first year tbat the
new law came into operation, and tbe president of the association and the
secretary were both most profoundly ignorant, at tbe time, of it.

Dr. Lavey. — Was it not tbe third year, Dr. Tuke ?

Dr. Tuke — We had entirely forgotten the rule which bound us to have
balloting papers. It was purely an error on the part of tbe administration
which 1 veiy much regret. We were very anxious to carry out the law,
and if we had thought of it we would have done so. I may mention, that
immediately after that, when Dr. Robertson suggested tbat Mr. Cleaton,
the new Commissioner in Lunacy, should be made an honorary member, I
stated that it was necessary to give notice of such nomination. This will
show how extremely anxious I was to carry out the rules which you hare
laid down for our guidance.

J}r, Wood. — I think, gentlemen, it will be unnecessary for us to occupy
any more time in this discussion. I am pleased to gather from the obser-
vations Dr. Davey has made, that he is satisfied that the omission was an
accidental one. We can sympathise with him in the spirit in which he has
acted, because, of course, it is only right that there should be a strict ob-
servance of tbe rules by which the association is to be governed. We wish
to do all that we can. do to remedy the defect in the last election, and there-
fore we will now proceed to the ballot. Grentlemcn will be kind enough to
put on slips of paper the name of the person they think proper to nommate
as president for the ensuing year.

The ballot was then taken.

Br. Wood. — Unfortunately we are not quite unanimous, there being one
vote for Dr. Davey. I do not think we need say anything about tbe num-
bers, but simply say, '* So and so is elected."

l)r. Christie. — It is not necessary that every candidate for the president's
chair should be proposed and seconded ?

I)r. Wood. — ^I think not.

Dr. Christie. — Otherwise there seems to be rather an anomaly.

Dr. Wood. — I think the rule is, that the election should be open. Any
member of the association can put down any name he thinks proper. The
idea was that it should be perfectly free to each individusd member to
suggest any name be likes, and then take the chance of whoever got the
majority.

Dr. Christie. — That is all very well, but it seems like putting up a man
to be knocked down by a snowball, if we do not know who is proposed and
seconded. Any one might be made the laughing-stock of others. It is
very invidious, that Dr. Davey's name should be put down in this way.

Dr. Manley. — As I understand it, the Question upon which tbe ballot is
taken, is whether Dr. Robertson is to be elected or not.

Dr. Davey. — The chairman has rightly stated the law.

Dr. Manley, — If you propose only Dr. Robertson's name, and say, " shall
he be elected as president or not," then it will stand good ; but if, on the
other hand, any other person's name is to be put down there may be a
difficulty. The fact is, there has been an error committed, and we are now
endeavouring to rectify it — that is all. If you are not satisfied, you had
better put up half-a-dozen names.

Dr. Davey. — Dr. Robertson is duly recognised as the incoming president,
and what is being done is in perfect harmony with the law of the society.
I do not think a word can be said against it. If gentlemen take objection,
there is only one course to pursue, and that is to give notice that they
intend to propose at the next meeting that there should be an alteration in
the law.

1867.] Notes and News. 383-

Dr, Wood. — I shall simply now record the fact, that Dr. Lockhart Robert*
son was elected as president. (Hear, hear.)

The president's chair was then taken by Dr. Lockhart Robertson.

The President. — Gentlemen, I thank you for this second election which
you have kindly bestowed upon me. We found on the last occasion, that
the reading of tne president's address, in the morning, took too much time,'
and we, therefore, on this occasion have resolved to defer it till this after-
noon, so as to be able to devote the whole of the morning meeting to the
general business of the association, which, with your leave, therefore, I
shall at once proceed to introduce to your notice. I received a letter of
great regret from Mr. Commissioner Browne, stating that up to the last
moment he intended to be here with us to-day, but that very pressing
business has unavoidably detained him. Letters have also been received
from Dr. Hitchman, Sir James Coxe, Dr. Campbell, Dr. Aitkin, Dr. Skae,
and Dr. Williams, of Gloucester. I think, before proceeding to the other'
business, we had better go on with the election of the officers for the
ensuing year, and the choosing of the place of meeting. If any gentleman
has any proposal to make with regard to our place of meeting for the year
1868, I shall be happy to hear it. The meetings, I may remark, were, it
was understood, to be held in London as much as possijDle.

Dr, Sheppard. — The meeting was held last year in Scotland, and has been
held in Ireland also. I beg to propose, that it be held in London again,
next year, as by far the best place for such a purpose.

Dr. Henry Stewart. — I beg to second that. I am from Ireland myself,
and I am inclined to think that occasionally it would be a very good plan to
have a meeting in Ireland, and occasionally in Scotland, so that we might
all have an opportunity of meeting together. It was, I think, about seven
years ago, that the meeting was held in Ireland, and, perhaps, in two or
three years hence it might be thought desirable to hold it there again. Of
course we shall be very glad to have the association pay us a visit, but still,
I may say, that we are always very happy to come over to London to attend
the meetings.

The resolution was put, and agreed to without opposition.

The President. — The next subject will be the election of president for the
ensuing year.

Dr. Manley. — I have the pleasure to nominate as the president for next
year, Dr. Sankey, a gentleman who is well known.

Dr. Davey. — 1 believe my friend is quite out of order in nominating any
gentleman for president. It is not at all in harmony with the rules. I am
sorry to be continually intruding upon the attention of this meeting, but it
is perfectly out of order, and is done nowhere else.

Dr. Stewart. — A name may be proposed. The object of the rule was to
avoid any nomination by the council. To propose and nominate are two
very different things.

Dr. Davey. — I don't see how you can propose and not nominate.

Dr. Maudsley. — Dr. Davey cannot preclude me or any member from get-
ting up and mentioning the name of any gentleman as being suitable for the
office of president. It appears to me, that any member of the association
has the right to do that, and there is no rule of the society to prevent it. I
therefore second Dr. Sankey's nomination.

Dr. Davey. — I give notice, that I shall bring forward that rule for amend-
ment— ^I mean the present rule — so as to make it explicit and unmistakable,
that no name shall be given.

The President. — But, in the mean time, I think it is distinctly in accordance

384 Notes and Netos. [Oct.,

with the rules, that any gentleman may mention any name he thinks proper.
It strikes me every member has that power.

Dr, Sheppard. — Will you be good enough to read the rule.

The President read Kule I A.*

Dfn Davey. — I say that language cannot justify the nomination.

The President. — Well, I think it is an open question. This year, at all
events, I must be allowed to rule that until the point is more strictly de-
fined, any member sitting at this table has a right to nominate any other
member he pleases.

Dr. Manley. — If no nomination is to take place, how are we to decide be-
tween the different candidates.

J)r. Lavey. — By a majority, of course.

Br. Manley. — But if no person's name is before you, how are you to know
whom to vote for P

Br. Chrislie. — I wish to give notice, that I shall propose an alteration in
the rule to the effect that every member who is a candidate for the presi-
dent's chair shall be proposed and seconded, and also that it may take place
the year before.

The President. — Does any gentleman propose any other member this year
for election ?

Br. Christie. — I an\ not out of order, I suppose, in proposing another
candidate ?

The President. — Not at all.

Br. Christie. — I should like then to propose Dr. Donald Campbell.

Br. Tuke. — ^Before that motion is seconded, may I ask Dr. Christie (as a
personal friend of Dr. Campbell's, and of his too) to withdraw it, for this
reason, that if we have a second nomination, there being no possible ob-
jection either to Dr. Sankey, or Dr. Campbell, and it being for the good of
the society perfectly immaterial which of those two gentlemen is selected to
be the president — if we have a second nomination, it may appear to be a
slight to the gentleman who is not elected.

The President. — I asked if any other gentleman was proposed or seconded.
(Chair, chair.)

Br. Monro. — Allow me to say a word on the principle of nominating or
not nominating. It seems to be a very unadvisable step, and it is not in
accordance with the mode in which the President of the College of Phy-
sicians is elected. There it is a free ballot. You know it puts us all in an
exceedingly uncomfortable position— this sort of thing going on. As my
friend Dr. Sankey was proposed, I did not like to say a word either against
him or for hinu Of course there are other gentlemen who might be named,
and it is exceedingly uncomfortable to have to publicly oppose an individual,
a friend, for whom you have a regard, and who, I am perfectly certain,
would make a most excellent president. But I am also a friend of Dr.
Campbell's, and I think it would be a great deal the best plan if we did not
name, any one ; but let it be a free and open ballot. (Hear, hear.) And,
as you encourage me with your cheers, I point to that which always influ-
ences Englishmen, I mean precedent — the precedent afforded by the practice.
of the College of Physicians.

Br. Wood. — When a motion is before the meeting it is perfectly compe-
tent to a member to make any remarks he thinks proper ; therefore, I think
Dr. Tuke was in order just now, in what he said when commenting upon
the motion that was moved, and we are now in this predicament, that we
have two motions before us, and before anytiiing else can be done, those

* In consequence of the frequent reference to the Rules of the Association
^ daring this Annual Meeting, they are printed as an Appendix to this Report.

1867.] Note^ and News. S8B

motions, with the coiisent of the chair, must be withdrawn. We cannot
allow the election to proceed until those motions are formally withdrawn.
Of course it is competent for any number of comments to be made upon
them, bui before we can revert — I think, Dr. Davey is right as regards the
proper course to take — before we revert to that we must get these two
proposers to withdraw.

A Member, — I understood the President to ask if any gentleman wished
to propose a candidate Either this is the law, or it is not. We had better
keep to something or other.

The President. — As I understand the law at present, I think it is distinctly
within the power of any member of this Association to propose a member
for the ballot. Dr. Manley did propose one member, ana Dr. Christie
another. I am prepared to hear now a third, or a fourth.

l)r, Christie, — I was rather surprised to read Dr. Davey's remarks, be-
cause he speaks in his letter of the monopoly of power by a f^w. If only
one gentlemen is to be nominated, all that any one has to do is to take care
that he has a friend who will jump up immediately and propose his name,
and then there can be no opposition.

Lr. Daoey, — Excuse me —

Dr, Christie. — ^I cannot conceive, therefore, that it is a good thing for one
name only to come before the meeting. M^ idea is, that we should have an
opportunity of choosing from several candidates. I do not wish to put one
forward in an undue degree, but I merely propose a gentleman who, I be-
lieve, will do us an honour by becoming^ our President.

Dr. Davey. — It has been said that 1 uphold the practice of nominating
one gentleman for the Presidency. I have never done any such thing. If I
did, I should deserve the remark which has been made upon me ; but it is
not in harmony with the facts of the case.

Dr. Tuke.-^l think I am in order in speaking on this resolution, and I
think that, never having missed one single meeting since I was originally
elected a member of this Association, I may be permitted to say that the
harmony and good feeling of this meeting would be very seriously interfered
with if we run, in this way, two names together. I speak from knowledge of
this matter, for this reason, that I was myself put up as President with Dr.
Skae, and it was not pleasant to have the names read out, and then to find
myself finally rejected by a majority of two. I do not think that is a fair
thing. What I propose is, that we first send round the ballot box for Dr.
Sankey. If he is unanimously elected cadit quastio, and if he be not elected
send it round for another, but do not run two names together, throwing a
perfectly undeserved slur upon the defeated candidate.

Dr. Henry Stetoart. — ^Why not proceed according to what Dr. Monro said.
The President tells us that there is no rule about it — that the law does not
bind one way or another. Why not now, without any name being mentioned,
send round the ballot box for next year ?

Dr. Wood, — I think if we asked the gentlemen to withdraw we should
then act upon precedent ; we should meet the objection of our friend Dr.
Davey, and leave everybody free to put down any name he thinks proper.
I think we^ can hardly fail to be right in what we do, if we do the same as
is done with regard to the election of the president of the College of
Physicians. I would, therefore, appeal to the gentlemen to withdraw the
propositions which they have made.

Dr. Manley.'—l have pleasure in withdrawing after what has been said.

Dr. Christie. — I shall be happy to do the same.

The President. — Then I understand this meeting bows to Dr. Davey's
reading of the rule.

Dr. Christie,'— ^o\ I did not say that. I must say, with due deference to

VOL. xin. 87

SbA Noiu and JVwt, [Oet^

Dr. Wood, that Dr. Robertson is in the chair, iCnd that he has decided
that we are strictlj within the rale in proposing members as candidates.

Dr, Wood. — It is only for the sake of harmony that I suggested it.

Dr, Monro, — I must say one word. It seems to me that the principle of
naming anybody upsets the ballot altogether.

A Member. — 1 quite agree with Dr. Monro. ^ •

Dr. fTood. — It IS not a personal mattec ; but I think, as a fact, it would
be the better way.

TAe President. — I understand, then, there is no name before the meeting.

Dr. Wood.'^I propose that we proceed to the election upon the principle
of the College of Physicians ; that each gentleman should haye a piece of
paper, and write upon it the name of the gentleman he wbhes to be elected.
(Hear, hear.)

Dr. Monro. — I second Dr. Wood's proposition.

Dr. Henry Stewart, — I perfectly agree with that, and if that plan is not
followed I won't vote at all.

Dr. Christie. — Is not this a fVesh proposition altogether ? Dr. Davey can-
not put such a resolution now.

Dr. Wood. — It is not Dr. Davey's proposition.

The President. — The feeling of the meeting appears to be against my
reading of Rule 9. According to my reading of it, certainly every memb^
may propose a candidate for the Presidency.

Dr. Christie. — ^I think we are bound to submit to your ruling.

The President. — I think it is an open question. 1 read it in one way, and
the feeling of the meeting reads it another. I bow to the feeling of the
meeting, and I advise the meeting to proceed quietly to the ballot.

Dr, Wood.^-lt is only for the sake of harmony, with no personal feeling
whatever.

A Member, — It is the custom of societies in general to nominate and
second.

Dr, Christie, — ^I shall move, as an amendment to Dr. Wood's motion, thst
members be invited to nominate and second candidates.

Dr, Davey. — If you wish to alter the rule, notice must be given.

The President, — ^Dr. Wood's proposition is, that we proceed to an election
by ballot without the names bemg first given, in accordance with the prac-
tice of the College of Physicians. Dr. Christie moves as an amendment;
that members be invited to nominate and second candidates.

The amendment was lost, and Dr. Wood's motion was put and carried.

Dr. Christie. — I give notice that I shall propose, at the next meeting, an
alteration of the rule regarding the election of President, to the effect that
every candidate shall be proposed and seconded.

Dr, Davey. — I believe my proposal for alteration comes before that.

Ths President — I have them both, Dr. Davey. I will now tLsk. the Secre-
tary to take the ballot.

Upon the ballot being taken, there appeared —

For Dr. Sankey . . . 13 votes

Dr. Campbell
Dr. Paul
Dr. Davey
Dr. Sheppard

9 „

2 „
1 »

The^ President. — Twenty-nine members have voted. There must be a
majori^of members ; therefore. Dr. Sankejr is not yet elected.

Dr, Wood, — ^We must^ have another election. I can only tell you that,
in the College of Physicians, the president must have the majority of fel-
lows present. Kobody has the majority of members present now.

1867.] Notes and News. 887

TAe President,--' I have ruled, and I think the feeling of the meeting U
with me, that Dr. Sankej has not the majority, and I must call upon you
again to record your votes for the two highest.

The ballot was again taken, and upon the Secretary calling over the votes
there appeared to be —

. For Dr. Sankey .... 16 votes
Dr. Campbell . . . 16 „

TAe President. — I find there are 16 for Dr. Sankey, and 16 for Dr. Camp-
bell. In giving my casting vote for Dr. Sankey, I may be just allowed to
say that I am intimately acquainted with both those gentlemen, and I am
sure either of them would do honour to the chair ; but I feel that, as Dr.
Sankey had 13 votes on the first ballot, and Dr. Campbell only 9, 1 am best
interpreting the wishes of this meeting in now voting for Dr. Sankey. The
next point for your consideration is the election of other officers. The first
question is, as to the Editors of the Journal. Has any gentleman any pro-
posal to make with regard to the Editors of the Journal 7

Dr, Manley, — I propose that the present Editors be re-elected.

Dr. Langdon Down. — I beg to second that.

Carried unanimously.

The President. — The next proposal is with regard to the Treasurer.

Dr. }fonro. — I beg to propose that Dr. Paul be re-elected as Treasurer. .

Dr Christie* — ^I shall have pleasure in seconding that.

Carried unanimously.

The President. — ^I'he next is the General Secretary.

Dr. Sheppard. — I beg to propose Dr. Tuke again.

Dr. Brushfield. — I secoua that proposition.

Carried unanimously. •

Dr. Tuke. — I am extremely obliged to you, Mr. President and members of
the Association, for electing me. l take a great deal of pride in the office
of Secretary, and rather prefer it to that of President. (Laughter.) I trust I
shall in future avoid the error into which we fell last year, and I repeat it
was entirely an oversight. Having very much at heart the interests of the
Association, I think in several ways it might be improved. I cannot do it
myself, but I venture to suggest that some member should give notice of a
proposition for meeting oftener, and particularly that our President should
De elected for two years instead of one.

Dr. Paul proposed that the Irish and Scotch Secretaries be re-elected.

Dr. Eastwood seconded the proposition.

The two retiring members of the Council were then re-elected on the
motion of Dr. Manley, seconded by Dr. Lindsay.

The President. — The next business that comes before us is the election of
three honorary members, and twenty-one ordinary members. The three
honorary members proposed are Stan-Surgeon Baron Mundy, Dr. Ludwig
Meyer, the first to mtroduce in Germany the practice of non-restraint, and
John D. Cleaton, Esq,, Commissioner in Lunacy.^

Dr. Davey. — Am I m order in making remarks in reference to the election
of honorary members ?

The President. — Quite.

Dr, Davey. — Then, with your permission, I will take upon me to say that
I do not myself feel quite satisfied with the manner in which we elect the
honorary members of our Society. I take it our object is to create an
aristocracy among ourselves, and very properly. I find no fault with that.
I admire it very much indeed : but, understand me, it is the manner in
which we proceed in the election of this aristocracy to which I am about
to take objection. Now, I happen to be on the committee of the Council^

"388 Notts and News, [Oct.,

and I have never had raj attention drawn to the merits of the question
now before us, in so far as the election of these several gentlemen is
concerned.

The Pretide/U. — Would you allow me to refer to the rule P You are
speaking contrary to Rule 8. It is not a question for the Council, but for
any six members of the Association.

Dr. Lavey, — I am much oblia:ed to you. Shall I be in order in making
a remark in regard to that rule ?

The Presideni.—CertBinly. ^

Dr. Davey. — I take an objection to that rule, and I think it should be
revised.

The President. — You had better give notice.

Dr, Davey. — Shall I be wrong in making a remark now ?

The President. — We are now electing the honorary members. You had
better give notice.

Dr. Davey. --1 give notice that I will move an amendment to the law
next year.

The President. — We proceed to ballot for the three honorary members
whose names are now before the meeting.

A Member. — We had better appoint scrutineers.

Another Member. — It will be exceedingly inconvenient to take all four
together.

The President. — Then I will take them individually. The first member
proposed is Staff-Surgeon Baron Mundy. (Applause.)

A Member. — I think you read a rule to the effect that the election was to
take place by ballot.

2 he President. — By ballot if required. It is necessary that there should
be a majority of two thirds. •

Dr. Wood. — I am extremely unwilling to intrude; but the rule, as I
understand you to read it, runs thus — ** That gentlemen, whether of the
medical profession or otherwise, who are distinguished, &c. . . the election
to be by ballot, as in the case of ordinary members.'*

The President. — Then read the rule as to the election of ordinary
members.

Dr, Wood. — " That the election of members take place by ballot — a ma-
jority of two thirds required." I think it is quite clear that we have no
right to depart from that.

A Member. — We have done it before.

Dr. Wood. — It is never too late to mend. There is the rule, and we must
observe it if we observe the rules at all.

The President. — Then we will take a ballot for the three honorary
members.

Dr Manley. — It is quite clear that, although we are obliged to vote by
ballot, it stands in our minutes that Baron Mundy has been carried by
acclamation.

Dr. Monro. — I thought it was agreed that we might put all three on the
same paper, so that the box need only go round once.

The President, — Then with regard to the other members, we have twenty-
two. Is it the pleasure of the meeting to have a separate ballot for them ?

Dr. Wood. — r think we had better take the honorary members first.

The President. — Then the Secretary will take the ballot-box round for the
three honorary members. You will please write either one, two, or three,
names on the paper.

Dr. Sheppard. — If we do not write the name of any one ?

The President. — Then you vote against them.

The ballot was then proceeded with.

1867.] Notes and Neivs. 389^

The PresidenL^^One of the auditors retires this year, and Dr. Sheppard«
as senior auditor, is the one. Has any gentleman any candidate to propose
in Dr. Sheppard's place ?

J)r. Monro. — I beg to propose Dr. Blandford.

Carried unanimously.

Dr. Christie, — There has been a misunderstanding about Baron Mundy.
Nobody has omitted it intentionally.

Dr, Tuke, — Baron Mundy's election has been carried by acclamation.

The ballot having been taken, it was found that the numbers for the
other two candidates were :

Dr. Ludwig Meyer .... .27
Mr. Cleaton 26

The President. — Mr. Cleaton and Dr. Ludwig Meyer are both elected
honorary members of this Association. Then, with regard to the ordinary
members, there are twenty-two candidates. Will the Secretary read the list
oyer ? It is understood that each gentleman shall either write *' all^" or write
any individual name that is objected to.

The Secretary read the following list :

Staff-Surgeon T. Blatherwick, Fort Pitt, Chatham.

Coyte Bailey, Esq., Three Counties Asylum, Stotford, Baldock, Herts.

Thomas Bozzard, M.D., 12, Green Street, London.

Edward Byas, Esq., Grove Hall, Bow.

John A. Campbell, M.D., County Asylum, Carlisle.

Edward Chaffers, Esq., York.

Balfour Cockburn, M.D., Fort Pitt, Chatham.

Charles Davidson, M.D., Bethnal House, London.

William Douglas, M.D., County Asylum, Lincoln.

G. H. Dodsworth, Esq., Bucks County Asylum.

Corbin Finch, Esq., Salisbury.

— Fuller, Esq., Ireckham House Asylum.

W. R. Gasquet, M.D., 127, Eastern Road, Brighton.

H. Minchin, Esq^ 56, Dominick Street, Dublin.

W. McLeod, M.D., Deputy Inspector- General, Great Yarmouth.

G. Mickley, M.D., Royal Hospital, Bethlehem.

I. Partridge, Esq., Woodville House, Lazells, Birmingham.

— Sabben, M.D., Northumberland House, Stoke Newington.
Edward Seaton, M.D., Suubury.

Thomas C. Shaw, M.B., County Asylum, Colney Hatch.
H. H. Stabb, M.D., St. John's, Newfoundland.
Andrew Smart, M.I)., Melville Street, Edinburgh.

THE IRISH DISTBICT ASYLUMS.

The President,'^! have received a communication from our associate. Dr.
Flynn, of the Clonmel District Asylum, with reference to the retiring clause
in the Irish Asylum Bill, now before Parliament. " We want (writes Dr.
FJynn) a just retiring allowance. At present we are merely civil servants on
sixtieths ; for, if a salary be £300 per annum for twenty years^ our retiring allow-
ance would be £100 per annum, and might be made only one half if local boards
so willed it, though appointed by the Government." I would ask Mr. Blake now
to make bume remarks in reference to the present Irish Bill. If the ar-
rangements ior retiring officers are such as are represented by Dr. Flynn,
they do not seem to be very equitable.

Mr. Biake^ M.P. — Mr. President and gentlemen, I think there is rather
Vi erroneous impression as to the measure in the House of Commons. The-

890 NoteM and Hews. [Oct.,

clause of the bill to which allusion is made, and which is complained ci, only
provides that in case an officer himself chooses to retire after a certain time
nis remuneration shall be upon the same principle as that of an officer of the
civil service ; but there are some preceding r^ulations with regard to the
medical officers of Irish lunatic asylums which I think are of a more liberal
character. The bill has already passed the Commons, so that we have no
control over it. It has passed the third reading, and may come before the
House of Lords to-morrow. It is quite certain that under that bill, and
under preceding acts, the medical officers are only provided for under the
same circumstances as members of the civil service, and I must confess that
I think a more liberal clause should be introduced, and therefore if you wish
I shall be very happy to do anything in my power for that object. Perhaps
you will pardon my saying that I am not disposed to go to the extent Dr.
Stewart suggests with regard to the remuneration of our medical officers.
Now, he tells me that his idea is — he will correct me if I am wrong — ^that
after fifty an officer ought to be allowed to retire if he chooses. I must con-
fess that, as a representative of the ratepayers, I should be rather reluctant
to allow an officer, unless owing to great exertion he has become incapaci-
tated, to retire at fifty years of age. I myself havepassed my fortieth year,
and I should be very sorry if I was told at fif^y that iwas beyond service. I
have given the subject of lunatic asylums my full attention, and I should be
very glad, when you do consider the (question, to go as far as I can with
you. What I desire to apply myself to is this, which I am sure will be re-
ceived with great satisfaction by those gentlemen whom I have the honour
of addressing connected with Irish asylums, though I apprehend some of
those who are aspirants for situations will not receive it with satisfaction.
You are aware that hitherto the practice has been in Ireland to require, as
the only qualificatipn of a gentleman seeking the post of medical resident
superintendents of asylums, the production of his diploma as a member
of the College of Physicians in Ireland. It has hardly ever been inquired
into whether they had any knowledge whatever of the treatment of the
insane, or ever saw the inside of a lunatic asylum, or ever had any oppor-
tunity, beyond mere reading up on the subject, to acquire any knowledge
upon a branch of the profession which requires peculiar knowledge ; but it
so happens in Ireland that a gentleman sees the appointment vacant, and
proceeds to write to anybody with whom he is acquainted, possessing Parlia-
mentary influence, in order to obtain it ; the consequence is, thut a very
great number of gentlemen receive the office of medical superintendents and
officers of lunatic asylums who are not properly qualified. I took the oppor-
tunity when the bill, which I just now spoke of, was passing through the
house, to introduce a clause into it to the effect that no appointment should
be conferred unless the person nominated should receive a certificate from
the Inspector- General of Lunatic Asylums in Ireland that he was considered
competent by reason of having a sufficient knowledge of the medical treat-
ment of insanity. Lord Naas, the Chief Secretary for Ireland, objected to
do that, as he considered it would place it took much in the hands of the
Chief Inspector of Asylums in Ireland, and make it rest very much with
him to say who should be appointed. They said, that if I would consent to
withdraw my amendment, they would undertake that immediately a fresh
rule should be introduced in the Privy Council, giving a preference for all
future appointments to gentlemen who have gone through a certain proba-
tion in lunatic asylums, and had a practical knowledge of the moral and
medical treatment of insanity. I consider that very important, and am
quite sure that it will be received with satisfaction by the very important
body I have now the honour to address, and I think it very desirable that it
should be mentioned in the next issue of the periodical, in order that future

1867.] Notea and News.- 3»1

aspirants should become aware that one essential qualifioationrwiU be a pr^c*
tical knowledge of the subject.

MB. BLAKE*8 PROPOSAL 70A ▲ BOTAL COMMISSIOV.

Mr. Blake, M.P, — The next matter, upon which I will occupy a very few
minutes of your time, is to ask whether I can obtain from the Society con-
currence with regard to a matter upon which I have already received a large
amount of support. It is a matter which very intimately concerns you ^1
here, and perhaps you will pardon me if for a very few minutes I call it to
your attention. There are some gentlemen here who have taken an interest
in the Irish lunatic asylums, and endeavoured to introduce a better system
in so far as affording the patients greater liberty, and also giving them in-
creased occupation of a suitable character. In order to inform myself on
the subject, I visited almost every lunatic asylum in England, and a great
number elsewhere. In the course of my investigations on the subject I have
found that there is a very great deal of difference as regards the moral
treatment in the different asylums in England and Ireland and on the Con-
tinent. We find in oiie asylum a very great amount of amusement, recrea-
tion, and so forth, and in other asylums very little or nothing of the kind,
but they take more the character of hospitals. Last year I wrote a small
pamphlet on the subject, which I have not the least intention of reading to
you now, but which I have presented to some of the members present. I
will, however, with your permission, read a short paragraph to explain
exactly what I mean. This was a paper read before the Social Science
Congress, entitled ** The Moral Treatment of Insanity, and suggestions for
the appointment of a Koyal Commission to inquire into the Treatment
pursued in the Asylums of the United Kingdom, and to report upon the
system which appears best adapted for carrying out the most approved
Principles of Moral Treatment." The passage runs thus : — '* I should be
glad to pause here and offer a well-merited tribute of praise to the manner
in which some of our English and Irish asylums are conducted. I am only
restrained from referring to a few of them by name by the consideration
that my silence respecting other institutions might be construed as a tacit
censure upon their management and conduct. In a work upon the subject
of the defects of public asylums, which I published some years since, I have
entered more fully into this question than the limits of this paper would
admit of my doing on the present occasion, nor is it my purpose just now to
travel beyond the general principle of moral treatment. Conceding, as I do,
that all public asylums have, since 1792, made steady progress in the direction
of a more successful and enlightened principle of treatment, and feeling con-
vinced that the moral treatment of the insane, by kindness, occupation, and
amusement, is now firmly established, I would venture to ask why is the
principle now carried so much further in some institutions than in others ?
And, again, would it not be possible to lay down some general code of rules
and regulations for the guidance of all public and private asylums in the
United Kingdom, and thus afford to their inmates the fullest advantages,
limited only by local circumstances of liberty, occupation, and amusement ?
In visiting public asylums at home and abroad, I have often been struck by.
the different principles which appeared to guide the governing powers of
almost neighbouring institutions. Thus, in England the asylums of Leices-
ter and York have absolutely no boundary walls — nothing beyond a quick-
set hedge ; while other English county asylums are protected by the old,
conventional, high, prison-like walls ;.and I may add that the official returns
of these respective institutions show that the attempts to escape are less
frequent in the unwalled than in the walled asylums ; and, what in a fiscal
point of view is of greater importance, the number of attendants required is

392 Notes and New9. [July,

less. At Gheel, in Belgium, the lunatics are confined by no boundary limit
whatever ; there is no wall, no hedge, no line of demarcation between the
mentally afflicted patient and the healthy colony in which he finds a refuge
and a home. Indeed, in this admirable lunatic colony I witnessed the insane
and the sane working side by side at their various avocations, and with this
almost incredibly encouraging result — that whereas Gheel receives only such
cases as are deemed incurable, it actually cures 18 per cent, of its, I was
going to say, inmates ; it would be more appropriate to term theni guests.
At Turin, again, I saw at the Manicomio Kesio restrdnt imposed in many
objectionable forms — patients, for instance, oound and strapped to their
beds. Only sixty miles off, in the Manicomio at Genoa, almost all restraint
was discarded, and the sleeping-rooms of the patients were not even isolated
by a door — a curtain alone extended across the opening. The same dis-
parity in the line of practice pursued prevails amongst the asylums of
the United Kingdom. Perhaps I ought not to include Scotland, as I have
not personally visited the Scotch asylums. In some of the asylums of Great
Britain and Ireland the most enlightened modern principles of treatment are
carried out to the fullest extent, and with the most gratifying results ; the
patients enjoy a considerable amount of liberty ; healthy occupation and a
fair proportion of amusement are provided for them ; they are treated with
kindness and confidence. In other asylums the same principles of treatment
appear to be in their infancy, judging by the extent to which they are prac-
tically carried out. In point of fact, as asylums are at present governed,
the inclination or the indolence of the resident staff of officers determines the
extent to which the patients shall benefit by principles whose adoption is
now admitted to afford the best means for their restoration to the blessings
of an unclouded reason. Some of the institutions of this country, in which
the moral treatment of the inmates appears to be a matter of indifference
to the staff, are little better than county gaols, where the lunatics are merely
detained in safe custody ; they are, no doubt, clean, orderly, and comfort-
able ; but they hold out little prospect of exercising a curative influence
upon their inmates." Now, what I was peculiarly anxious to prove was
this — the advisability of getting a Royal Commission appointed in order to
inquire into the various systems, with the view of seeing whether some
general rules could not be laid down for the guidance of all public and
private asylums. When I said that some of the institutions of this country
were little better than county gaols, I was speaking of the asylums of my
own country, which I know better than others. In some, such as those
with which Dr. Stewart and others are connected, everything is as it ought
to be. I felt it was only due to you that, before I took a decided step in the
House of Commons, I should lay the subject before you for your advice ;
and if you think the proposal is injudicious, I will pay that deference to your
judgment which is necessary by not proceeding in that direction.

Dr, Tuke, — ^I am sure this Association must feel obliged to members of the
House of Commons who take an interest in this matter, and I don't think
any one has done more for us than Mr. Blake. If he will give us anything
tangible, which could be put in the form of a motion or a distinct resolution,
we shall be able to deal with it.

The Fresident. — Mr. Blake is simply come to ask if the feeling of the
Association is with him.

Mr. Blake. — I should like to give the President, as I have already given
the Secretary, a copy of my pamphlet. Should you agree to co-operate
with me as an Association, you might, as gentlemen residing in different
parts of the country, exercise a very great amount of influence. The
' Lancet' and several other papers strongly advocate the proposal ; and if I go
to Parliament 8trengt<hened by your approbation, and with the certainty of

1867.] Notes and News. 393

gettinir whatever local assistance you can give, I am quite certain we shall
be able to carry it.

Baron Mundy. — I think it extremely important to know if Mr. Blake's
motion in the House of Commons has been brought on.

JLTr. Blake. — 1 had it on the books for some time, but did not get an oppor-
tunity of bringing it on.

Dr. Wood. — If I understand the proposition now before us, it is that we
should pass a resolution, saying we believe that a Eoyal Commission would
be of essential service to the interests of the insane. I think we all do feel
that, and we must certainly feel greatly indebted to Mr. Blake. No doubt
the opinion of the Association goes for something, and it would be a matter
of duty if it can be carried out. Therefore, I would suggest that we have
a resolution drawn up from the chair to that effect, and I sliall be happy to
move it.

Dr, Belwrave, — I very much hope that this Society will accede to the pro-
position that has been made by Mr. Blake, as I believe very great benefit
would be derived. I would respectfully submit that a deputation from this
Society should wait upon the Secretary for the Home Department, and, if
possible, interest him in the matter. I remember one on one occasion, some
few years ago, on a matter of great consequence, similar in its character, and
the result was that the subject was taken in hand, and the desired reform
accomplished.

Br, Wood, — I am not quite sure that in this instance sending a deputation
is quite the proper form of action, because I presume the members of the
House of Commons are the parties to appeal to. The appointment of a
Commission does not, I think, rest with the Secretary himself, but it is a
question entirely for the. decision of the House. Mr. Blake will correct me
if I am wrong, but I think it is in the discretion of the House.

Mr, Blake. — Probably it is too late to do anything this session, but if you
pass a resolution, and draw up a memorial, it might be exceedingly valuable
at the commencement of next session for as many of the members of the
association as possible to wait upon the Secretary of State.

Br. Monro, — May I ask whether it would not be well to appoint a com-
mittee to work with Mr. Blake ? If the Association approves, and I think it
does, of the object of Mr. Blake, I would move that a committee be ap-
pointed to assist him in his parliamentary efforts.

Br. Tuke. — I beg to second that.

Br, Belgrave, — Mr. Blake himself being an ex-officio-member of the
committee.

Br, Wood. — The committee would arrange the deputation and arrange
the memorial.

Br, Monro. — It is suggested, first, that, as a body, we approve of the ap-
pointment of a Royal Commission, and, as I understand, Dr. Wood has
proposed that the Association should express that approval. I go further
than that, and move that we wait upon the Home Secretary in order to get
him to inform us as to the course to be taken.

Dr. Christie. — Then we are voting for a Royal Commission to inquire
into the treatment of the insane throughout the world, I suppose P

Dr. Wood. — No ; simply throughout the United Kingdom.

Br. Christie. — I merely want to know what we are voting for.

The President. — The'proposition moved by Dr. Wood is as follows : — ** That
this meeting considers it most desirable to have a Royal Commission ap-
pointed for the purpose suggested by Mr. Blake, namely, to enable it to
mquire into the treatment pursued in the asylums of the United Kingdom,
and to report upon the system which appears best adapted for carrying
out the most approved principles of moral treatment.".

394 Notes and News. [Oct.,

Tk, Wood, — I would suggest that the special reference to lunatio asylum^
should be omitted, so as not to limit inquiry. Suppose we saj, '* to inquire
into the best manner of providing for and treating the insane, and those
reputed to be insane, in the United Kingdom/*

Dr, Monro. — " And that a committee be appointed for the purpose of
giving effect to the wishes of the Association."

Dr. ffood. — That comes afterwards.

Dr, Monro. — ^I think it is a very important thing that we should understand
whether we request the Commissioners to go into the present or present and
past treatment of asylums, or whether it is to go into the question of what
ought to be in the future ; because if this commission is to go into all the
asylums of the country at present, it will go directly into the work of the
Commissioners in Lunacy.

Dr, Wood. — That is not what is proposed at all.

Dr. Monro. — I certainly think that this Association and Mr. Blake, and
every one concerned in this matter, ought to communicate with the Commis-
sioners in Lunacy ; it would only be polite to them. Of course, if the
commission is only to go into the question of finding out what is
the best way in future of treating the insane, it would not interfere
with them ; but otherwise it would seem as if we were proposing a Koyal
Commission which should supersede the Commissioners in Lunacy alto-
gether.

Br. Wood. — The resolution says, "to inquire into the best manner of pro-
viding for and treating the insane and those reputed to be insane." The
object, therefore, is distinctly for the future.

Dr. Monro. — 1 see the words have been altered. They were originally such
as to lead to the inference that it wa^the existing treatment in asylums which
was to be inquired into. That is not your intention ?

Br. Wood.— Oh dear, no; certainly not.

Dr. Monro. — It is not a retrospective judgment that is required, but a
prospective one ?

Dr. Wood. — Certainly.

Br. Tuke. — I propose an amendment upon the resolution which has been
moved by Dr. Wood. I propose " That a committee should be appointed
who should represent the Association and take such steps as they may think
fit in conjunction with Mr. Blake." By adopting this course the Association
would not be committing itself to anything.

Br. Monro. — I second that, because I think the first motion may appear
to go a little further than a simple proposition of this kind.

Br. Wood. — We first want to determine what the opinion of the meeting
is before we take any steps in the matter. Are we or are we not of opinion
that we should go into the thing judicially ? Certainly the meeting is com-
petent to determine the first grand question — is it or is it not right that this
iioyal Commission should be applied for ? Surely it is better to determine
that by putting it to a large meeting than by putting it to a select few.
Thereibre I am disposed still to stand by my original proposition.

Br. Christie. — I am very glad Dr. Tuke has brought forward his amend-
ment, as it appeared to me we were on very dangerous ground. I think we
are travelling very fast. I am quite satisfied that the Commissioners in
Lunacy have done a good deal. The improved treatment of insanity has
taken a strong hold upon the profession, and the Commissioners have brought
an influence to bear which no Royal Commission such as that suggested can
ever bring. It seems like saying they have not done their duty. I thmk
we ought to be very cautious how we proceed.

Br. Wood. — ^I must disclaim any such idea. I am not in the least degree
reflecting upon the great service which the Commissioners have rendered to

1867.] Notei and News. 395

the cause of insanity ; but after Mr. Blake has taken the trouble to come and
ask our opinion I think we ought to say whether we think he is right or not
in asking for a Koyal Commission

Mr, Blake. — I will just describe what the action of the inspectors is.
They see the house and so forth, but never make any rules for the
guidance of the establishment as regards moral treatment, but it is left
entirely to the officers of the asylums themselves. Now, my object is not
so much to find fault with the existing systems as to devise the subject-
matter of rules to be introduced in future. I am very far from wishing to
bind this Association all at once to an opinion in favour of a Royal Com-
mission. I wish you to give the matter what weight you think judicious.
If I have the honour to meet a committee of the Association next session,
we can consider the matter, and you can then give us authority to act in
whatever way you think best.

Dr. Manley. — All our asylums are managed by committees, who draw up
strict rules for the guidance of officers and servants, and it is the business
of the Commissioners in Lunacy, not only to see that persons are properly
taken into asylums, but also to go to the different houses and see that the
rules are carried out, and, if there are improvements to be made, to record
their opinions in a book that such and such changes should be effected.

Mr. Blake. — I have known cases in which the same state of things has con-
tinued for many years. In the case of one asylum the inmates were well
dressed and well fed, and all the inspectors passed it as a most excellent
asylum, yet there was nothing in the way of exercise or recreation going on;
and the very same thing exists in some asylums at present. Some are not
a bit better than county prisons.

A Member. — I can bear testimony to the Commissioners carrying out the
very things you suggested in the asylums round London. They especially
look to the moral treatment and amusement of the insane ; for instance,
going to the seaside, the theatre, &c. It is the same at all the houses in
the neighbourhood of London, I think. All these things are specially taken
care ot by the Commissioners in Lunacy.

Dr. Monro. — Considering that the hour of the afternoon meeting has
arrived, and that Mr. Blake in his last speech has agreed with the amend-
ment rather than the proposal, viz. that a committee should be appointed
to go into the whole subject, and that we should not go quite so far as the
proposal itself— and considering that Mr. Blake was the centre and the
origin of the whole thing — probably the mover of the motion will withdraw
it, and allow the amendment to be put instead.

Br. Wood, — As I made the proposition entirely to suit Mr. Blake's views,
I am perfectly willing to withdraw it.

Dr. Sheppard. — With the view of saving time and shortening the discus-
sion, I was going to propose (which seems a curious way of doing it) another
amendment. There is a great deal of truth in what Dr. Monro and Dr.
Christie have said about the dangerous ground on which we are treading,
and therefore I submit this amendment — ^* That while we thank Mr. Blake
for the interest which he has taken in the welfare of the insane, we feel that
in entertaining the proposition we are altogether losing sight of what the
obvious answer of the Government would be, namely, that a Koyal Commis-
sion would supersede the duties of the appointed guardians of the insane —
the Commissioners in Lunacy — and be the establishment of a most dangerous
precedent." I need not make any remarks upon it at all.

Dr. Wood, — It surely could not have that effect at all.

Dr. . — I have much pleasure in seconding the amendment of Dr.

Sheppard.

&r^ Wood. — ^The original motion is not before the meeting now.

396 Notes and Neios. [Oct.,

Br, Sheppard. — Then you withdraw it ?

Dr. Wood, — I have already done so.

The President. — It is now more than half-past two. Is it the pleasure of the
meeting that we should adjourn or continue business ? I am in your hands.

Or, Christie, — I should think we had much better adjourn for a few
minutes.

Dr. Take, — I move that a committee be appointed to act as the general
council to represent the Association, and taKe such steps as they may think
proper in the matter suggested by Mr. Blake. The names I propose are
Mr. Blake himself, Dr. Blandford, Dr. Christie, Dr. Brushfield, and
Dr. Monro.

Dr, Sheppard, — ^I submit the amendment which I have already read.

Dr. Tuke's motion was then put.

A Member, — I must rise to order. Dr. Sheppard*s proposition is not an
amendment on Dr. Tuke's motion at all. It happens to be an amendment
on Dr. Wood's motion, which has been withdrawn. Dr. Tuke's proposition
is now put forward as a substantive motion, and therefore the amendment
goes into a question which is not dealt with in the motion at all.

The President. — Suppose we put Dr. Tuke's motion.

Dr. Sheppard. — You have already put it, but no one votes for it.

Dr, Monro. — It has been misunderstood.

The President. — Who votes in favour of Dr. Tuke's motion P

The motion was put and lost.

The President, — The next Question is as to the adjournment. At what
time is it your pleasure to hold the afternoon meeting ? It is now twenty
minutes to three.

Dr. Christie. — Suppose we say three o'clock ?

The proposal for adjournment was then agreed to, and the meeting was
adjourned accordingly till three o'clock.

Afternoon Meeting.

The President. — We have got through in the morning the whole of our
business, the election of our officers and the place of meeting next year, and
also the very important subject which Mr. Blake was kind enough to bring
before us. The other matter of general business which we have before us
is a letter from the Societe Medico- Psychologique of Paris. There was a
notice inserted in the last number of the Journal calling attention to the
very important meeting that takes place in Paris on the 10th, 11th, and 14tb
of August.

Baron Mundy^ — The 10th, 11th, and 12th; the 14th is changed to thel2th.

The President, — And the members of this Association, among others, are
invited to attend. I have received a letter from M. FoviUe, in which he
says —

*| Dr. Robertson is specially requested, as President of the Medico-Psycho-
logical Association, to favour us, if possible, with his presence, and to ex-
press to the members of the general meeting, on the 31st inst., the pleasure
with which the Societe Medico-Psychologique would receive them.

*' For the Board, A. Foville."

I hear that physicians from all parts of Europe are going, and I hope some
of our body will be present. It is at the Ecole de Medecine. I have also re-
ceived a letter froia Mr. Rumsey, member of the General Medical Council,
calling our attention to the question of degrees, and certificates, and quali-
cations in State Medicine ; and a resolution from Dr. Boyd, which, with your

1867.] Notes and News, 397

permission, we will leave to the end of the meeting. I shall again, should
time permit, refer to these afler the business on the Agenda is all completed.

The subject on which I propose to address you to-day is the important
question of The Care and Treatment of the Insane Poor. {See Part /, Original
Articles^ Article L — *' The Care and Treatment of the Insane Poor.
By C. Lock hart Robertson, M.D. Cantab., President of the Medico-
Psychological Association/*)

Dr. Christie. — I rise with very great pleasure to propose a vote of thanks
to our President for the very able address he has given us this afternoon.
It has afforded me very great gratification to hear his remarks with reference
to the idiots, as upon that very subject I took upon myself to sketch out a
plan for the Chairman of the Commissioners of Lunacy this year. Unfortu-
nately it has not been taken up by that board, but I am in hopes that, by
the aid of Dr. Robertson, it may be taken up. Every one knows the ter-
rible difficulty we have in the treatment of idiocy in county asylums, and
the tribute he paid to Earlswood is not at all undeserved. I cannot help
thinking if we can but take a model from that, and push the treatment of
idiots into the same sphere of usefulness as the treatment of the insane poor,
we shall not only be indebted to Dr. Robertson for this address, but we shall
be indebted to him for laying the foundation for it. It is with great plea-
sure I propose a vote of thanks to him.

Dr. Langdon Doton. — I have very great pleasure in seconding the vote of
thanks proposed by Dr. Christie, and join most heartily in applauding that
portion of the address relating to the treatment of idiots. 1 feel that Dr.
feobertson has been too complimentary to Earlswood, but, however, I should
only be too happy to see multitudes of Earlswoods throughout the land.

The resolution was unanimously agreed to.

The President* — I now call upon Baron Mundy for his address, {See
Part /, Original Articles^ Article II. — ** A Comparative Examination or
THE Laws of Lunacy in Europe. By Baron Mundy, M.D.")

Dr. Belgrave. — I have great pleasure in proposing a vote of thanks to
Baron Mundy for his address. 1 may mention that he excluded two countries
which do possess lunacy laws, namely, Russia and Denmark. Denmark
possesses a definite code of lunacy laws, and Russia has an indefinite code,
if I may so express myself; that is to say, a number of disconnected laws,
which a council is now engaged in converting into a regular digest, so that
they will eventually have a more definite code of laws than we ourselves
possess. Then Baron Mundy made one remark which I can testify not to be
correct, and that is, that the asylums in Russia very much resemble the con-
dition of Bedlam in ]^ears gone by. I am acquainted with a large number
of asylums, and I believe that the asylum in connection with the University
of St. Petersburg is the best organised and best designed for the purposes
of tuition of any asylum in Europe. Every arrangement is good, not only
for the recovery of the patients, but also for imparting mstruction to
medical students. I consider we are greatly indebted to Baron Mundy, as
we necessarily must be to physicians who bring to us an account of their
works. I have great pleasure in proposing a vote of thanks.

Baron Mundy. — I know nothing about a law in Russia ; they are merely
ordinances and rules, but no law. And even in Denmark there is nothing
that you may call a Parliamentary Act at all; they are just detached ordi-
nances, detached rules, but a real law is not in existence. With regard to
Dr. Belgrave's remarks about Russia, I quite agree that the hospital to
which he refers is a very good one. But to sav that, because one asylum in
such a vast countrv as Russia is sufficiently tolerable, therefore all the other
asylums are tolerablei is a proposition to which I cannot assent. If you will

398 Noie9 and Newi. [Oct.;

kindly show me the law of Denmark and Russia I shall be very much
obliged to you.

Mr. G. W. Mould. — I rise, sir, for the purpose of confirming Baron Mundy.
Some four weeks ago I sent two of my attendants to Moscow for a patient,
an English gentleman of large property, who had been shut up in an asylum.
They described the state of the asylum as dreadful. The medical man lived
three miles away, and yisited the asylum only once in ei^ht days. This
English gentleman had not any clothing upon him. Two pillow-cases were
wrapped round his thighs in a filthy dirty state. He had been confined in a
strait waistcoat, and had four attendants. YHien they wished to go near
him and give him any food, they took hold of the four corners of a sheet,
threw it over his head, and pulled him head oyer heels. That is the descrip-
tion my attendant gave of the asylum. I think there are 400 patients, but
that is the way they are treated.

Br. Morris. — I beg to second the yote of thanks, and also thank Baron
Mundy for the great interest which he takes in the Association.

The President. — We are extremely indebted to Baron Mundy for his
kindness in coming over from Paris to attend this meeting. I am sure if
there is a member who deseryes well of this Association it is the Baron, who

foes through Europe raising the fame of the English school of psychology,
n every quarter of Europe does he sound our praise and make known our
ffood deeds ; and I am sure the Association have only shown him a yery
fitting honour to-day in making him an honorary member. He was not
present in the room ; but I may tell him we excluded him from the ballot,
and elected him by acclamation. I now call on Dr. Davey to read his
paper, "On thb Insane Poob in Middlesex, and the Asylums at
IIanwell and Colnet Hatch. By John G. DAyBT, M.D." {See Part I,
Original Articles, Article III.)

Dr. Tuke. — I rise to propose a yote of thanks to Dr. Dayey for his paper,
and I may take the opportunity of asking Dr. Dayey to re-examine his
statistics. I think if he does he will find he need not be under so much
alarm, as he evidently is, as to the increase of insanity. When the last Com-
missioners' report came out I analysed it yery carefully, with a yiew of
watching, as I am in the habit of doing, the statistical increase or decrease
of insanity ; and I found, as there can be no doubt, that the number of the
insane has enormously increased, especially in the home counties. Now, that
may be accounted for by the fact that the restless brain of a man about to
become insane would naturally lead him to leaye the country and come to
London, and we therefore get a number round the metropolis. Again, Dr.
Dayey does not take into account the increase of the population ; and he
has also forgotten, which is a very important thing indeed, the prolongation
of life in the insane. In point of fact, the increase altogether of the insane
during the last decade has not been anything so yery extraordinary ; and,
morever, when we take the number of the richer classes, and compare them,
who haye been better treated — I mean as far as duration of life has gone,
which has always been longer than the paupers — we find the richer class has
not increased at all, and, in fact, their numbers in relation to the population
have remained exactly the same. Therefore I think the increased number
of poor that we have discovered and carried to our asylums, the length of
life, and extra care that has been taken of them, fully account for the appa-
rently large increase of insanity ; and I do not in the least fear that we
shall have in the next ten years the enormous array Dr. Dayey has alarmed
himself with.

Lr, CAristie.'^l will second that. In reference to the remai^ of the
increase of inBanity« in the first report I issued, I called attention to that

1M7.J

■ tfe 5Mk Bifii^ A^in. ftr ^ ImI Mvoi ywi% llie

hms bem bo iiif iif lai ■» 4ummic ; tkti jear, I an lkip|>T to saj, w« bsre
hadlihksioadigMAMnMCL Ob mm amagt^ iWre fcaT» Iwm 500 paitWnts
in the sstIbb «■ tke 31st IXeeeBber. We kaiTe kad tkeai tkk T«ftr down to
480; at tke picjMt bbbehK we have -Iftt ; therefore I mm aDtici(Miti]ig what
Dr. BobertsoB hac itaied — tfcai we va^r WaTe seen tbe oatside of ike number
<^tbe

Tbe resolatioa

^ Jfmfcr.— Mar I adc wbift is tbe poHa^ioii of tbe Nortb Riding?

2V. drotie. — ^I leallf caaaot ^rre it joo, fat I bare not bad tbe tables put
before aw^ I migbt Mtinn, ahboi^b it is tbe Nortb Biding Asjlum, we
take tbe wbole of tbe patieBts from & nortb and east, so Ibat Uiere bas be^i
no dilferenee ai regards tbe popalatinnin tbat respect, WebaTerealljonlj

Dr. Befyrmwe. — ^Wbatever ooinion we maj entertain with reference to tbe
statistics of Dr. Davey; I tbiu we maj receire one suggestion of Terr great
consequence. Tbe experience of ererj member present will, no doubt»
confirm me wben I aaj tbat cases are mucb more curable when treated in
the incipient eoliditioo. I am aanj to saj in this large metropolis there is
no institation of the kind where the poor may in their incipient condition
apply and reoeire adTice or rdief. I respectfiulj suggest for the con^idera-
tioo of indiridual members tbe proprietj that some of us should establish a
&pensarj or bospitii for diseases of tbe brain and nervous system, by means
of which we could afford to the poor such assistance when they are suffering
from disease in an incipient condition as they may require. At tbe present
time ndtber at Bethlehem nor St. Luke's are patients received. In the
whole of the metropolis there is not any place to which poor relations can
apply for assistance wh«i they suspect the existence of mental disease.

Dr. BwdcuUl. — I wish to thank Dr. Davey for his interesting and valuable
paper, and to express my own opinion that he is right in recommending tbat
an hospital for recent cases should be established in this county in preference
to small asylums which receive chronic patients. I hope also tbat the sug-
gestion which has been thrown out as to the establishment of a dispensary
for suspected cases or threatened cases of insanity may not be lost sight of.
I know Dr. Johnson did much good in his experiments on the value ofopium
as a preventive of insanity, and I believe he carried out those experiments
almost solely amongst the out-patients of an hospital. Still, whether an
asylum for the chronic patients or an hospital for the curable patients may
be established, whatever may be the decision or tbe opinion oi the meeting
on that point, I think they must a^e with me that any division of the
patients in a county asylum which is not rendered imperative by previous
mistakes is in itself an evil. This is a question which has been forced upon
the attention of the superintendents of asylums for many years past ; and I
have always felt the greatest apprehension that if what are called the chronic
and incurable lunatics were taken out of the county asylum and placed in a
separate institution devoted to themselves, they would be treated in a very
different manner to that which we are accustomed to see in the present
county asylums ; and I have always feared that if the curable patients were
kept out of the county asylums, and these latter establishments were, therefore,
rendered receptacles for the incurable only, that the liberality of the visitors
would be so acted upon by the economy of the ratepajrers, that the curative
treatment which is now the treatment of all patients in the county asylums
generally would be cut down to what the ratepayers would consider the
requirements of the incurable.

Dr. Manro.'-'I rise to make a few remarks. I most thoroughly agree with

400 Notes and News, [Oct.,

whnt has just been said by Dr. Bucknill as regards the mode of treating the
curable and recent cases separately fr<»in the incurable and chronic ; and I
alsot nnrree with the idea that it would be an excellent thing to establish an
hospital for the curable a little way out of London. But the remarks which
Dr. Davey made would reailly go to intimate that there are no such places
as St. Luke's or Bethlehem Hospital in existence. I cannot .^it here and hear
it said that there is no place, that there is not any hospital, in London, where
the acutely insane poor can apply for entrance. All I can say is, if you are
not aware of the existence of St. Luke's, I beg to inform you of it. I think
Dr. Williams a little feels the same thing as I do on that subject. There was
one other point in Dr, Davey 's paper which, if it could be brought into
action, micht be of use, but 1 hardly see how it would be, and that is the
having a place for the reception of out-patients. It is a new idea altogether.
I do not mean to say that because it is a novelty it is to be set aside, but I
do not see that you could get men and women in the incipient stages of
insanity up to any central place, either in London or the country. I do not,
in fact, understand quite what the proposal is. A person, if he is insane, is
received into the hospital —

Dr. Davey. — I beg your pardon. Dr. Monro; I think the gentleman on
your left (Dr. Belgrave) made that proposal, not myself.

Dr, Monro. — It is an exceedingly interesting subject, but it comes before
me as a fresh matter altogether. I want to know exactly who these out-

Eatients are. Are they to be mad people or insane people ; or are they to
e persons who you suspect are going insane and want to take the advice of
a physician to prevent their insanity continuing ? I should like a little ex-
planation on that point. As regards the question of establishing an hospital
m the country for the treatment of the acute insane, I am sure I should be
very glad to assist in that, though it is not required to such a degree, I think,
as some of you imagine. I am afraid that Bethlehem and St. Luke's have
faults, but they are a little out of your recollection.

Dr. Rhys Williams. — I understood Dr. Davey to say the hospital he wished
to establish would be for the pauper class. One of our rules is, if they are

? roper objects for a pauper lunatic asylum, they are not fit for Bethlehem,
'herefore I think Dr. Davey's hospital might be formed without interfering
with St. Luke's or Bethlehem.

Dr. Tuke. — I take the opportunity to put in the report of the Statistical
Committee appointed last year. I do not think I can have the conscience
to inflict upon you the reading of my paper. I shall send it to the Journal,
and hope you will read it with the attention with which you would have
listened to me to-day. ("On Monomamia, and its Relation to the
Civil and Criminal Law. By Harrington Tuke, M.D. See part /,
Original Articles ^ Article 11.)

The Treasurer's report was read :

1867.]

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VOL. XIII.

402 Notes and News. [Oct.,

Dr. Maudsley moved, and Dr. Brushfield seconded, the adoption of the
report. Agreed to.

The Presuleni. — The only report we have not had before us is the report
of the Committee on Asylum Statistics. This committee was reappointed to
further consider the subject, and to make a second report. The six original
tables which we recommended have been already introduced into two-thirds
of the county asylums during the last year, and we have added to our pro-
posal two or three more simple tables, m vae of which the report explains.

Second Report of the Committee upon Asylum Statistics.

The Committee upon Atyhm Statistics have the honour to present their second
report to the Medico-Psychological Association,

Their first report (a copy of which is herewith annexed) was adopted hy the
Association at the Meeting o/*1865.

The Committee have now the gratification of reporting that the six tables recom-
mended by the Association have^for the reports of the year 1866, been adopted by
the medical superintendents of the public asylums enumerated in the annexed list,
including two in Scotland and one in Nova Scotia. The Committee believe the
Association are indebted for this success to the favorable notice of their labours in
the report of the English Commissioners in Lunacy for 1865.

In accordance with the resolution passed at the Edinburgh meeting in 1866, the
Committee have further considered the subject of asylum statistics, and submit
an extension of their uniform system in four additional tables^ being tables VII,
Vllly IXi X, of the series.

Table VII shows the duration of the disorder on admission in the admissions,
discharges, and deaths of each year^ according to the four classes recommended by
Dr. Thurnam in his work on the * Statistics of Insanity*

Table Fill shows the ages of the admissions, discharges, and deaths of each
year in quinquennial periods.

Table IX shows the condition in reference to marriage of the admissions,
discharges, and deaths of each year.

Table X shows the causes, apparent or assigned^ of the disorder, in the admissions,
discharges, and deaths of the year.

These tables are all of simple construction, and compiled with no great labour,
and include^ with the series of six tables already adopted by the Associa-
tion, the chief medical statistical results to be sought from our public asylum
records.

The Committeee have left the financial and domestic statistics unnoticed for the
present, save that they annex a general balance-sheet, readily compiled from the
various accounts now in use in the different asylums, which gives at one glance the
general income and expenditure of the year and on the capital account, and also
the average weekly expenditure per head on the weekly rate.

The Committee reprint herewith the former six tables adopted by the Association
in 1865. Table V (the causes of death) admits of some modification and
extension, according to the special requirements of each Asylum in respective years.
The modification which may be required is, of course, considerable. Such additions
can readily be made without altering the classification adopted. Thus to the division
cerebral or spinal disease may be added infiummation of the brain, tumours,
fyc. Sfc. One or two such additions are suggested in the revised table F,
Such an extension of the classification meets the suggestion on this point made
^" the Commissioners in Lunacy. This table may require further alteration

1867.] Notes and News. 403

when the report on the nomenclature and classificalion of disease by the College
of Physicians is published,

{Signed) JOHN THURNAM.

C. L. ROBERTSON.
HENRY MAUDSLEY,
Royal Collbob of Physicians ;
July 31*/, 1867.

Appendix.

A. Nominal List of Public Asylums in which the Tables recommended by the

Medico-Psychological Association have been adopted.

Argyll District Asylum.

Birmingham Borongh Asylum.

Bristol City Asylum.

Broadmoor Criminal Asylum.

Buckingham County Asylum.

Cumbenand and Westmoreland County Asylum.

Dorset County Asylum.

Glamorgan County Asylum.

Gloucester County Asylum.

Halifax Asylum, KoTa Scotia.

Hants County Asylum.

Lancashire Ciounty Asylum, Frestwich.

Lincolnshire County Asylum.

Monmouthshire Joint Counties Asylum, at Abergavenny.

Newcastle-on-Tyne Borough Asylum. *

Norfolk County Asylum.

North Riding Asylum.

Northumberland County Asylum.

Oxford County Asylnm.

Eoyal Asylum, Montrose.

Salop and Montgomery County Asylum.

Somerset County Asylum.

Suffolk County Asylum.

Surrey County Asylum, Wandsworth.

Sussex County Asylum,

Wilts County Asylum.

Worcester County Asylum.

B. Fi&sT Hepobt of the Committee upon Asylum Statistics.

At the annual meeting of this Association in 1864, it was resolved '* That
a committee of three, viz. Dr. Robertson, Dr. Thurnam, and Dr. Maudsley,
be appointed to draw up a series of tables, and a form of register which might
be the basis of a uniform system of asylum statistics ; that these tables be
submitted to the commissioners when drawn up, and that they be asked to
sanction and promulgate them." The committee thus appointed report as
follows :

1. That twenty-three years ago this subject engaged the attention of the
Association, and a form of register (which the committee annex to this re-
port) was adopted at the annual meeting held at Lancaster in 1842, which
contained all the information deemed necessary for the purpose of asylum
statistics. This form, however, on which Dr. Thurnam in particular, be-
stowed much pains, never came into very general use, having been shortly
afterwards, viz. in 1845, almost entirely superseded in practice by the regis-

401 Notes and Neios. [Oct.,

ter8 of admissions, discharges, and deaths, required under the Acts of 8 and
9 Vict. c. 100 and c. 126 ; which were re-enacted with slight modification by
the Acts of 16 and 17 Vict. c. 97, and c. 100; and which Acts are still in
force.

larly kept. . - j j

aflbrdintr the means for the compilation of statistics more full and extended
than those which can be deduced from the legal register.

The committee are not at present prepared to recommend to the Associa-
tion the printing of a second and revised edition of its register (a step which
would involve a considerable outlay), unless a suflScient number of the mem-
bers pledge themselves t(» its adoption and use.

The committee trust, however, that whenever the time may arrive for the
revision and consolidation of the Acts, under which asylums, hospitals, and
licensed houses are regulated, the opportunity may be taken, with the appro-
bation and sanction of the Commissioners in Lunacy, to revise the legal
registers, by the omission of a few columns which to the committee appear
superfluous, and by the introduction of a few others required for the prepa-
ration of medico-statistical tables.

2. Asylum statistics may be divided into three distinct heads :

1. Medical statistics.

2. Financial statistics.

3. Domestic statistics.

The committee, while fully recognising the value of a uniform series of
asylum statistics in illustration of each of these departments of asylupi ma-
nagement, yet propose on the present occasion to confine their suggestions to
the first and more important branch, viz. that of Asylum Medicul Statistics.

3. The committee have carefully examined the various and varying tables
in the several asylum reports. They are of opinion that the information
more immediately necessary for medical statistics, may be given in the tables,
forms of which they annex to this report.

Table 1 gives the number of admissions, re-admissions, discharges, and
deaths, with the average numbers resident during the year ; the sexes being
distinguished under each head.

Table 11 gives the same results for the entire period the asylum has been
in operation.

Table III furnishes a history of the yearly results of treatment since the
opening of the asylum.

The table also embraces a column for the mean population, or average
numbers resident in each year. In other columns are shown for each year
the proportion of recoveries calculated on the admissions; and the mean an-
nual mortality, or the proportion of deaths, calculated on the average numbers
resident. It is of the first importance that these two principal results under
asylum treatment, when given, should be calculated on a uniform plan, and
according to the methods here pointed out.

Table iV gives a history of each year's admissions, how many, for example,
of the patients admitted, say in 1855, have been discharged as cured, how
many have died, and how many remain in the asylum in the year reported on.

The value of this table in regard to the vexed question of the increase of
insanity is evident. The table is adopted from the Somerset Asylum Reports.

Table V shows the causes of death classified under appropriate heads.
This form is adopted from the reports of the Commissioners in Lunacy for
Scotland, with some addition and modification. It appears sufficiently de-
tailed for statistical purposes.

1867.] Notes and News, 405

Table VI gives the length, of residence in the asylum of those discharged
recovered, and of those who have died during the year.

The committee are of opinion that the introduction into all the asylum
annual reports of the few simple tables here referred to, the compilation
of which would not be very onerous — would be a most desirable proceeding*,
and would supply in a uniform manner the main facts required for statistical
comparison. They accordingly recommend their adoption to those members
of the Association by whom they have not hitherto been employed.

The tables recommended, however, are regarded by the committee only in
the light of a principal instalment of those which are desirable. Their use
will not, of course, preclude that of other tables, according to the views
which may be entertained by the different superintendents. Hereafter it
may be expedient that the committee should report as to the propriety of
recommending to the members the assimilation of other tables to a common
standard.

The committee annex to their report the following documents : —

1. The forms for statistical tables which they now recommend.

2. The form of register adopted by the Association in 1842.

3. Copy of a paper by C. Lockhart Robertson, M.D., on " A Uniform Sys-
tem of Asylum Statistics," read at the meeting of the Association, July 5th,
lb60.

(Signed) JOHN THURNAM..

C. L. ROBERTSON.
HENRY MAUDSLEY.
Royal College op Physiclsins j
July \Uh, 1865.

C. Opinion op the Commissioners in Lunacy (Annual Report, 1866),
ON THIS First Report of the Committee on Asylum Statistics.

" The importance (observes the Commissioners) of adopting in all asylums
a uniform system of statistical tables and registers has long been felt by us,
and we are glad, to find that the subject has recently been again under the
consideration of the Medico-Psychological Association, at whose last meeting
a committee to whom it had been referred submitted forms of tables which
were adopted and recommended for general use. These tables, confined to
medical statistics, are simple in form, and only include the main and most
important facts required to constitute a basis for more elaborate and detailed
information.

** The superintendents of most county asylums publish in their annual
reports tables more or less elaborate, and containing a large amount of valu-
able information. While, however, the facts recorded may be identical in
many if not most of the reports, the form in which they are recorded varies
80 greatly that it becomes impossible to tabulate them for the purpose of
showing general results.

'* In any future legislation it would no doubt be desirable, as suggested in
the report alluded to, so to revise the present * Registry of Admissions * as to
include some of the more important particulars required, in order to obtain
correct statistics of insanity. But in the mean time we trust that, with the
view of facilitatinir statistical comparison, the visitors and superintendents
of all institutions for the insane will not object to adopt the forms of tables
recommended, which will be found in Appendix (I).

Table I gives the number of admissions, readmissions, discharges, and
deaths, with the average numbers resident during the year ; the sexes being
distinguished under each head.

406 Notes and News. [Oct.^

" Table II gives the same results for the entire period the asjlum has been
in operation.

'* Table III furnishes a historj of the yearly results of treatment since the
opening of the asylum.

" The table also embraces a column for the meao-ponilfltai or cfcrage
numbers resident in each year. In other columns are fmown for each year
the proportion of recoveries calculated on the admissions; mnd the mean
annual mortality, or the proportion of deaths, calculated on the arerage
numbers resident. It is of the first importance that these two principal re-
sults under asylum treatment, when given, should be calculated on a uniform
plan, and according to the methods here pointed out.

'* Table IV gives a history of each year*s admissions ; how many, for example,
of the patients admitted, say in 1855, have been discharged as cured, how
many have died, and how many remain in the asylum in the year reported on.

^' The value of this table in regard to the vexed question of the increase of
insanity is evident. The table is adopted from the Somerset Asylum Reports.

** Table V shows the causes of death classified under appropriate heads.
This form is adopted from the Reports of the Commissioners in Lunacy for
Scotland, with some addition and modification. It appears sufficiently de-
tailed for statistical purposes.

'' Table y I gives toe length of residence in the asylum of those discharged
recovered, and of those who died during the year.

'* Uniformity in recording the ages of patients on admission, the duration
of the existing attack, and the form of mental disorder under which they
labour, is also very desirable; and it is to be hoped that the medical officers
of asylums may see the great importance of coming to some agreement
upon these points. How lar the table of the causes of death may require
modification or extension will be a matter for subsequent consideration/'

iser.]

Nole» and Newt.

D. Rbvisbd Sbbibs or Statibiical Tibi

Mile.

F^nrie.

Tot.1.

In Asf Inm, lal January, 186

Admitted for the flrat tima during the

—

Total admitted

Total nndsr care dming the year

Recovered

Relieved

Not improved

Died

».

of abaent on trial, mHi™, ; femolaa, ) ... /

Average nnmlier resident dnriiig tlie ;e

Peraona admitted during; the period of
Total of cases admitted

Discharged or removed

Recovered

Believed

Died

Total diacharged and died during the

Hem^ning. Decemher 31. 186

Average numhcra resident during the

M.I..

F.o,^».

TotkL

jears ...

jeara ,.,

jei

».

Not«t attd Newl.

[Oct.,

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1867.]

Notet and News.

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410

Notes and Newi,

[Oct.,

Tabls \,^Skomm§ ike Causes of Death during the Year.

Caasefl of Deatli.*

Male.

Cerebral or Spinal Disease —

Apoplexy and Paralysis

Epilepsy and Couyolsiong ...

General Paresis

Maniacal and Melancholic Exhaustion or Decay ...

Inflammation and other Dbeases of the Brain,
Softening, Tnmonrs, &c. ...
Thoracic Disease —

Inflammation of the Lungs, Pleorse, and Bronchi

Pulmonary Consumption ...

Disease of the Heart, &c. ...
Abdominal Disease —

Inflammation and Ulceration of the Stomach,
Intestines, or Peritoneum

Dysentery and Diarrhoea

Pelvic Ahscess

Exauthetnaia ... ... ••• .••

Erysipelas ... ... ..• ...

v^ancer •.■ ... ••» ..• ••.

Awetnia .., ... ••• ..• •••

General Debility and Old Age ...

Accidents, . ... ..• •>• ...

Sutciae ... ... ... ••• ...

Female.

Total.

Total

* This tahle may require modiflcation after the Report of the College of
Physicians on " Medical Nomenclature " has heen published.

Table Yh^Showing the Length qf Residence in those discharged Recovered^
and in those who have Died during the Year.

Length of Residence.

Recovered.

Bled.

Male.

Female.

Total

Male.

Female.

Total.

Under 1 month

From 1 to 3 months

>» 3 „ 6 |>

»> 6 „ 9 ,1 ...

„ 9 „ 12 „

„ 1 „ 2 years

>» 2 „ 3 „

f> 3 „ 5 „

« 7 „ 10 „

„ 10 „ 12 „

Total

1807.]

Nof.e» and Newt.

411

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9

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•a

-a

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412

Noles and News,

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1867.]

Notes and News.

413

••a

ft)

The Discharges.

Removed, Relieved, or
othemise.

•

•a

6
a)

•

The Admissions.

Causks.

Moral—

*.^. Mental anxiety

Domesti c troubles

Religious excitement

Disappointments in love
&c. &c. &c.

•

Phtsioal—

tf. ^. Hereditary taint

Intemperance

Onanism

Sunstroke

Unascertained

&c. &c. &c.

Notei and Neioi.

[Oct.,

iHCom mJ EzpiNSitD&B^ fAe Year ending 136

IHGOHI,

XlPEHDlTUU.

From Weekly rate

„ Un ion B contribn ting ...

„ Couuty irensarer

„ Unions ncin-.-oiitribatlng

For privHte pntiHntB

From Salaries, 4c

Total from Weekly rata..

Prom County rate

Improvemenw

Totftl from County rate ,.

From Weekly rate

l-rovisiona

Clothing

Salariea and wages

Honse Eipenaea

Uedicino, Wine, and Spirita
Incidentala

Total from Weekly rate

F(om County rate

Repaira and nltecationa ...

Total fi'om County rate...

»■

—

Total Income j

Atsbaoe Wbkklt EiraifDinrBE/or (Ae Yrar/or each Palienf.from Weetlg Ball,

Quulen indioj;.

18S.

Usrr^liSlit

Jm..30.k

Sept,30lh,|Dei^,31«.

Provirionfl

House niid otber Eipenaas

ClOthiDg

Balaries and Wages

Medicine, Wine, and Bpirit"

Total

Weekly Rute obarged to the Unioaa con-

tributing to the Agylam

Ditto ditto not contributing do.
Ktto ditto for Private Patiente

*. d.

t. d.

>. d.

1. d.

f. d.

ABBTBiOT OF CAPITAL AcCOtTNT.

£ : d.
Total Sums expended from the County Rate on the erection, fitting, 1
furniahing, and enlargement of the Aevlum from its commence- \
meat in to the praaent time J

Total Nnmhcr of Beda

1867.] • Notes and News, 415

The report of the Committee on Asylum Statistics was unanimously
adopted.

The President. — The next point remaining in the way of business is a Com"
munication from Dr. Boyd, calling our attention to tne provisions of Mr,
Hardy's Bill, and saying he thinks that that Bill might very reasonably be
applied to the relief of the insane in the provinces as well as in London. I
shall read Dr. Boyd's letters :

" SoMBESBT CoxnrrY Lfnatic Astlitm, Wells ;

July Sth, 1867.

** Dbab Db. Tuke, — Would you kindly place the resolution on the other
side for me before the annual meeting of the Medico- Psychological Associ-
ation on the 3 1st instant ?

*' The resolution is in accordance with the one I had the honour of pro-
posing at the meeting of 1865, which was agreed to. I was prevented being
at the last meeting, naviug to go for one of my children to Gerinany, owing
to the war, " Yours very truly,

*' R. Boyd.

"CoFNTY Lttnatic Astlum, Wells, Someeset;

July lUh, 1867.

" Deab Dr. Tukb, — I very much regret that the resolution I forwarded
loyou some days ago was too late to be. brought forward at the meeting on
the 31st. I was under the impression that a fortnight's notice was sufficient.

" Mr. Hardy's Bill is, in my view, a most important one, as I am convinced
that a proper provision for the poor in sickness would very materially
diminish the applicants for admission to county asylums, which to a consider-
able extent, for want of such provision, have become workhouse infirmaries.

** Hitherto, under the contract system, official relief has not been given or
generally provided for the sick poor, and it is not surprising that under such
a system the asylums for the insane poor in which suitable provision is made
should after a time become inconveniently crowded and their efficiency
diminished.

'* It appears to me that Mr. Hardy's Metropolitan Poor Law Bill, if
extended to the whole kingdom, would counteract this tendency to the dis-
proportional increase of insanity amongst the poor; and I consider the.
subject so important that I shall feel greatly obliged if you will read this
note to the meeting, which I exceedingly regret circumstances prevent my
attending. I must beg to decline for the present the honour yon so kindly
proposed, and, with many thanks, remain,

•' Dear Dr. Tuke,

" Yours faithfully,

" R. BOTD."

Resolution proposed by Dr. Boyd :

"That this Association highly approves of Mr. Hardy's Metropolitan
Poor Law Bill, especially the provisions for the care of idiots and the insane
in workhouses, and hopes that in the next session of Parliament the Bill may
be extended to the whole kingdom, so that the idiots and insane poor may
be provided for without inconveniently increasing county lunatic asylums."

I think Dr. Boyd must have misunderstood Mr. Hardy's Bill. The Bill is a
specially exceptional Bill for the wants of London. It would lead to great
waste of power were such similar interference with and suspension of the
local self-government of the country introduced generally. As Dr. Boyd is
not here, I suppose it is hardly competent for us to entertain a resolution
that he sends us by post, only I could not bring this subject to your notice

416 Note% and News. [Oct.,

without stating my dissent from Dr. Boyd's proposal. The Quarter Sessions
and the Boards of Guardians are quite competent to deal with the insane and
sick poor in the counties without the introduction of an^ third authority.

Next I wish, without further intruding on our limited time, to call
your attention to a letter which I have received from Dr. Bumsey, rela-
tive to his important proposal for the institution of degrees in State
medicine. I shall read Dr. Kumsey's letter, which is adaressed to Dr.
Williams, the Consulting Physician to the Gloucester Asylum :

" WOLSELEY HOTTSB, CHELTENHAM;

"Jtt/y 3r(£, 1867.

'* My dbab De. Williams, — On the whole, the ' Medical Times' gives
the best version of my few and imperfect remarks in Council on June 7th,
but even that report is very incorrect ; so I send you a copy, with correc-
tions of some errata, which I am sure are not due to myself

" I shall be much obliged to you to let your son and Dr. Robertson see
this copy.

** I am anxious to draw their attention to my suggestions of a prolonged
education, to be followed by the grant of a special ' (qualification* for Psycho-
logical physicians, medical jurists, experts, and sanitary officers, so that the
public and the authorities might know who are the proper persons to employ
for such special duties. Of course, no distinction of the kind would be
necessary for those whose reputation in these departments is already made.

** I need not trouble you by recapitulating my reasons for this proposal ; but
I may say that when Dr. Christison argued the question against me/rom the
chair (which, by-the-b^, deprived me of the usual opportunity of reply),
he was quite mistaken in assuming that I had any objection to tf// the medical
students in Edinburgh attending his lectures on * Medical Jurisprudence
and Toxicology.' I said nothing which ought to have been so interpreted. I
merely deprecated requiring more of the ordinary student, as necessary to his
admission into the professioUy than he could possibly accomplish ; and 1 urged
the importance of instituting a higher qualification after longer study and
observation for a special class of medical students. To none would such a
requirement apply more beneficially than to future psychologists.

** I hope that Dr. Robertson may see the matter somewhat m this light. I
enclose my former paper for his acceptance.

'* His recommendation would give great weight to the proposal. Dr. Anstie
has already backed it virtually, and I am satisfied that it is gaining ground
among thinking men. I mean to make another fight for it at Dublin.

** Always yours,

*' H. W. RuMSEr."

Lastly. Dr. Brushfield has kindly brought with him a new patent night
tell'tdfey as distinguished from those clocks that have been in use, and whicn a
re certainly very easily tampered with, and not of very much value. Per-
haps he will kindly say a few words in explanation of the model on the table

Dr. Brushfield, — It is impossible to overrate the great importance of an
efficient system of night watching in all large asylums, whether they be of a
public or a private character. This department generally causes so much
anxiety to the superintendent that a good and reliable night attendant
appears naturally and very properly to be looked upon as one of the most
important members of the working staff of a large establishment for the
insane ; more especially when it is considered that the checks and supervision
capable of being brought to bear upon the attendants whose duties are con-
fined to the day are ina{>plicable and inoperative to those having eharge'of
the wards during the night. The only plan of a mechanical description,

1867.] Notes and News. 417

which can be devised to operate as a kind of check, is one which, in the first
place, will prove the attendant to have been awake during his period of duty ;
and, in the second, to have visited certain portions of the building at stated
hours. Any simple means of satisfactorily proving the accomplishment of
these highly desirable points must do much to relieve the mind of the super-
intendent as to the vigilance of the night attendants. Hitherto this has been
done by fixing, in places to be visited by the attendants, clocks of a peculiar
•construction, having a series of pegs or studs so arranged on the dial as to be
capable of being raised or depressed simply by means of a cord, thus regis-
tering for a temporary period the time of the visit, but being in all other
respects beyond the attendant's control. In the morning some ofiicer has
visited the clock, ascertained whether the proper number of visits have been
made, according to the position and number of pegs displaced, and then resets
them for the following night. Now, apart from the heavy expense of this *
plan, rendered necessary by a clock being required at every station to be
visited, there are some other objections of a more serious character. For
instance, the attendant frequently has to wait for a few minutes before he
can displace the peg, owing to his visit not being well timed. Again, I have
known the case of a patient who was bribed to sit by the clock and pull the
cord at stated times, whilst the attendant was asleep or occupied in some
other portion of the building. Moreover, the person whose task it is to
inspect the clocks in the morning may not report to the superintendent any
actual neglect or irregularity (or, vice versa, may report irregularities which
have not happened), as shown by the proper pegs not having been displaced.
It is therefore hardly to be wondered at that peg clocks have not been more
generally employed in asylums, or that in several instances their employment
has been abandoned. These objections have, however, been completely
obviated by an apparatus of much more recent date, which is not only dis-
similar in principle and construction to the ordinary peg clock, but possesses
the great advantage of registering the visits by a process of transfer printing.
It is known as Dent*s portable tell-tale, and is made by Mr. Dent, the well-
known chronometer maker in the Strand, who has been good enough to lend
me some examples to exhibit to this meeting.

It consists of two distinct parts — (1) a small portable clock; and (2) a
number of type-boxes.

The clock is a circular brass box, measuring 3^ inches in diameter and
1^ inch thick. It weighs less than 1^ pound, so that it is light and portable.
In the front face are two openings, a small glazed circular one below showing
the dial, and a narrow slit above guarded by two pieces of thin indiarubber.
A leathern handle is riveted on to the back part. The clock can only be
opened by means of the proper key, which is usually kept by the head
attendant or some other officer. On unlocking and removing the cap, a
paper dial is seen, having at its back a piece of black transfer-paper, both
Deing secured by means of a brass nut to a watch movement, which revolves
on its centre once in every twelve hours.

These paper dials are printed on both sides into divisions marking the
hours and quarters ; but the under side has these divisions continued to the
centre, and also a number of concentric circles, the effect of which is to
divide the spaces for each quarter, from the centre to the circumference, into
ten squares ; but, for a reason which will be presently obvious, the hours of
the two sides do not correspond, six of one side being opposite twelve of the
other, five to eleven, and so on. The type- box is circular in form, made of
cast-iron, 5\ inches in diameter, and 2 inches thick ; the front of it hinged
as a lid, and closed by a sprins lock. On opening the lid a small printer's
type is seen projecting into the interior from the back part of the box. A
different type is used in each box, and its position from the centre varies in

VOL. XIII. 29

[0(*,

1867.] Notei and News. 41 9

«Bch. One of these boxes ia let into Ibe wall in BeTeral portions of the
building requiring to be visited. The nigbt attendant, on making his
rouiida, takes hia dnck with him, and on arriving at a atatioii opens the tv^-
box, introduces the clock, presses it gently, and so registers his visit. (There
are three projecting studs on its circumference, which fit into grooves sunk
in the outer wall of the box, and so prevent the clock being introduced in
anj other way except the proper one )

Shows the type boi opened, and the clock bein^ intfodnn^.

In the morning the officer who has the ke; unlocks and removes t^e cap
of the clock, takes off the dial paper, and substitutes a. fresh one for it,
having first dated it, and then forwards the former to the Buperin ten dent.

The operation of passing the clock into the type-box canses the type lo
enter the slit on its front face, and to leave its printed impression on the
dial, through the agency of the block transfer -paper beneath it. It has been
mentioned that every box contains a different type, and, as a matter of con-
venience, an alphabetical sequence is the most simple, so that the first station
may print A, the second B, and so on. These letters are so arranged that
the one at the first type-box is printed on the first square of the dial-paper
nenrest the circumference, the second on the second, &c.*

These tell-talea appear to me to possess the several great advantages : —

* Instead of an alplial)eticHl arrangement, a word may be nsed, providiuK it
does but contain two similiir letters. At the Chesbire Asylum, where lour stations
were required for the male and five for the female wards, I employed the word
MALE for the former and WOMAN for the Utter.

420 Notes and News. [Oct.,

of being comparatively inexpensive;* of being light and portable ; of afford-
ing the attendant an opportunity of knowing the hour at any time; of any
fravd on the part of the attendant being, as far as can be foreseen, almost
impossible ; of the attendant being able to register in a simple manner, and
without serious loss of time, every visit made, no matter how frequently
repeated ; of the superintendent being able to receive, at first hand, a regis-
tered record of snch visits, or to satisfy himself whether they have been duly
made during his temporary absence.

Now, although strongly advocating the use of these tell-tales, I do not
for a moment venture to affirm that an attendant has satisfactorily performed
his duties because his dial-papers prove him to have made the prescribed
number of visits. There should be other corroborative proofs, positive and
negative, that whilst having actually visited the wards he has paid personal
attention to the patients, such as the absence of complaints of neglect, threats,
or ill-treatment ; the absence of " unaccountable" bruises ; the attention to
the sick ; the proportion of wet and dirty beds, &c. &c. But the very
knowledge that the times of his visits are registered is a powerful induce-
ment for him to make his rounds regularly. It is a matter of high import-
ance for the superintendent to feel assured that an farming escape of gas,
an outbreak of fire, or other equally pressing emergency, is more likely to be
discovered much earlier than in the absence of the employment of such a
check ; and, if no other advantage accrued from it, this would be reason
enough for its adoption. Take another example : in a long^ dormitory con-
taining several of the most suicidal patients, a type-box may be so placed
that the attendant must traverse the whole line of beds to arrive at it. Under
such a system of periodic visitation is not an instance of self-destruction
during the night less likely to happen ? Again, on the occurrence of a
homicide, suicide, death from epilepsy, &c., during the same period, the
attendant would be able to prove (which he scarcely could under any other
plan) the actual time he was in or near that particular ward where the
occurrence took place — a matter of the highest importance to himself, and
of great moment m an^ inquiry before the coroner, the committee of visitors,
or the Commissioners in Lunacy.

I have practically found their employment to be an invaluable adjunct in
carrying out an efficient system of night- watching, and in this opinion I am
borne out by the experience of several superintendents of other county
asylums, amon^ whom I may mention Dr. Christie, of North Riding, and
Dr. Bayley, of Northampton. They were introduced at my request into the
Cheshire Asylum, in October, 1865, and continue in regular use there.

In thus bringing under your notice a simple, ingenious, and comparatively
inexpensive invention, I have acted on the principle that everything which
tends practically to facilitate the anxious and onerous duties of asylum

• The following details of the cost are given by Mr. Dent : —

Comparative Cost of Tell- Tale for 20 Stations.

By the present system : —

20 Peg Clocks at £6

By Dent's Portable Tell-Tale:—
1 Watch Movement

20 Type Boxes at 15*.

1 Box of Dials ...

1 Leather Pouch and Belt

Difference

• • •

120

£6 0

15 0

0 10

• ••

• • •

£98

1867.] l^otes and News. 421

superintendents is worthy of being brought under the notice of the members
of this Association.

Dr, Christie. — 1 may say 1 have had this clock in use, and find it exceed-
ingly efficient and cheap. The clock costs £6 and each box 15^., con-
sequently you can adapt it to any institution you like at a comparatively
small cost. I calculate that by introducing this 1 saved our committee at
least £100.

The President, — I have one or two notices about alterations of rules at the
next annual meeting — those dreadful rules, — and Dr. Belgrave has further
given an additional notice that it be taken into consideration whether more
frequent meetings for the perusal and discussion of papers should not be held
in London, which notice is seconded by Dr. Rys Williams.

Dr. Maudsley. — I will take the opportunity of adding another motion for next
year — a motion for making the President eligible, at the end of his year of
office, for re-election, at any rate for another year.

Br. Tuke. — I have given notice for that this morning. Will you second
it?

Br. Maudsley. — If you have given notice of it, I will second it.

Br. Christie. — Before separating, I think we are bound to pass a vote of
thanks to our President for his conduct in the chair, and for the very able
manner in which he has conducted the meeting.

Br. Maudsley seconded the motion, which was carried unanimously.

Br. Tuke, — I am sure we shall offer our unanimous thanks to the President
and Fellows of the College for their kind permission to meet here to-day,
most graciously given to us by Sir Thomas Watson and the Fellows some
five years ago, and which has since been continued. I beg to move a vote
of thanks to the Fellows and President of the college.

Br, Langdon Bown. — ^I will second that.

Carried unanimously.

The President. — Nothing has done the Association more good in the opinion
of the profession than having the use of this College. It has raised our
standing very much, and I am sure we owe the College our grateful thanks
for their continued courtesy.

The proceedings then terminated.

Annual Dinner of the Medico- Psychological Association.

The annual dinner was held in the evening at Willis's Rooms, Dr.
Lockhart Robertson, President, in the chair. There was a large attendance
of members, including several honorary members. Dr. Bucknill, Dr.
Tweedie, &c. Among the guests present were Dr. George Johnson ;
Dr. Radcliffe; Dr. Brewer; Rev. Henry Hawkins, M.A. ; T. W. Nunn,
Esq. ; Edwin Sercombe, Esq. ; Dr. Hoskins ; Dr. L. C. Williams ; Ernest
Hart, Esq. ; Dr. Markham ; Dr. J. G. Glover ; Dr. Pitman ; Spencer Smythe,
Esq. ; Dr. Westphall (Berlin) ; Dr. Sieveking, &c. &c. &c.

The dinner was well served and of good quality.

422 Notes and News. [Oct.,

Session extraordinary of the Medico-Psychological Society of Paris^
held August^ 1867, under the presidency of M. Paul Janet ,
Member of the Institute of France,

The first meeting was held on August 10th, 1867. The President delivered
an able address, of which the following is an abstract.

The reception within its bosom of so many eminent physicians, the distin-
guished representatives of mental medicine in the several countries of £urope,
is an event that affords the highest pleasure to the Medico-Psychological
Society, and is one abo of which it may well feel proud. We hope this
meeting may not be in vain, but that the social intercourse and business of this
day may in future give rise to more intimate and more frequent association
between our own and foreign learned societies, and between ourselves and those
students and practitioners who here honour us with their presence. And fur-
ther, maj the progress of industry and science bring about the reunion of all
peoples m one common brotherhood.

Tet it happens that notwithstanding the pacific character of industrial art, a
certain degree of rivalry of interests will be felt among men. Not so, however,
in the case of science, which knows no other rivalry than that generous emula-
tion in the arduous pursuit which makes the student unwiUing to be out-
stripped in the search after truth. A noble jealousy, that without creating
heart-burning and hate, ever provokes its subjects to further progress. . . .
Truth is too wide and too profound to be made the subject of exclusive the-
ories. No formula can be invented to embrace it in its totality. Hence these
large concours open to free investigation on all scieutific subjects throughout
the world, where all may resort and bring with them their opinions, their
reflections and their conclusions. Hence also those periodical reunions charac-
teristic of the various learned societies, and likewise those rarer gatherings
on a grander and international scale, known as congresses. So ambitious a
title as this last it is not our wish to apply to the family reunion here pre-
sent ; but by whatever name it be designated it welcomes with pleasure ail
those who honour it with their presence, and we bid them accept in the same
cordial manner we would render it, our modest hospitality.*

M. Lunier (inspector-general of asylums) rose to make a proposition relative
to the statistics of the insane. He remarked how great confusion and error in
medicine, and in administration, result from the absence of a uniform system of
statistics in all places. An immense advantage would accrue from the prepara-
tion of such a system, which mi^^ht be generally adopted. We are constantly in
the habit of referring to statistical papers for assistance in the study of ques-
tions resting upon such facts, and it is a matter of the deepest regret that no
international uniform system of statistics for Europe at large is in existence.
This regret is felt as much by physicians in other countries as by our own
countrymen. 1 therefore propose the nomination forthwith of a commission
to proceed at once to the preparation of a scheme of statistics.

This proposition was accepted, and a commision formed of the following
gentlemen :

Messrs. Roller and Griesinger for Germany; Bucknill and H. Tuke for
England ; Borrel for Switzerland ; Pujudas for Spain ; Lambroso for Italy ; and

* The foreign psychological physicians present were Drs. Griesinger, Roller,
Harrington Tuke, Pujudas, Sibbald, Borrel, Cramer, Fistcherine, Berling, J.
Masty Artigat, Mundy.

1867.] Notei and News, 423

Lunier, Jules Falret, and Brierre de Boismont for France. M. Motet to be
general secretary to the commission.

M. le Baron Mundy next addressed the meeting on the subject of the public
provision for the insane. He confined himself exclusively to the financial
aspect of the question. He remarked that in France considerable sums were
expended in the construction of new asylums which would be mnch more pro-
fitably employed in the inauguration of another system, that namely flourishing
at Gheel, where so many ** See labourers" were found collected together.

M. Lunier replied that the proportion of such labourers at Gheel is far from
equalling that to be found in tlie best class of asylums of France.

MM. Brierre de Boismont, Morean de Tours, Pujudas, and Mundy took part
in the discussion of this question.

M. Lunier afterwards commenced the reading of an essay on the comparative
legislation for lunatics in various countries, and particularly on voluntary seclu-
sion.

The meeting broke np at 6 o'clock p.m.

Second Meeting, August 12th.

Present : Messieurs EoUer, Griesinger, Tuke, Pujudas, Kramer, Lambroso,
Flstcherine, Sibbald, Cortyii, Jo. Masti y Artigas, together with a large number
of corresponding members of the Society.

M. Griesinger opened the discussion by some observations on the question of
instruction in mental medicine. In his opinion the separation of psychological
medicine as a distinct subject from that of other maladies of the nervous sys-
tem, is uncled for. He has obtained the sanction of his government to unite
with the service of mental maladies one for nervous disorders, and thereby con-
siders that an immense advantage is secured both to the pupils and the teacher,
inasmuch as it is possible to observe the phases of transition between nervous
and mental derangement. Li this " service" all the affections of the nervous
centres are collected, and those mixed forms are encountered which are not
referrible to insanity though they may constitute its groundwork. Nothing of
the like kind exists in any other country, and in M. Griesinger's experience no
prejudicial consequences to the insane have ever resulted from clinical instruc-
tion in asylums.

M. Lunier expressed his approval of such a clinical service, but stated that it
would be impossible to institute the like in France ; for the law intervened to
prevent the removal of a patient suffering from a nervous malady to an asylum.

M. Moreau de Tours remarked that a scheme somewhat analogous existed at
the Salpetriere. The ** service" of the hysteric, of the hystero-epileptic, and of
the epileptic is separated from the '* service" of the insane, but when epileptics
are attacked with mania, and are dangerous, they are removed to the depart-
ment for the insane. M. Griesinger's plan is excellent, but in France it would
be encompassed by enormous difficulties.

M, Griesinger replied that the difficulties apprehended were not found at
Berlin. The service worked without any embarrassment. Only a moderate
number of patients is required for clinical instruction. I have one hundred
patients, and find this number ample. The arrangement at the Salpetriere is
inadequate ; something more is needed to adapt it to the scientific requirements
of the age.

M. Delasiauve. — ^The service alluded to is not constituted upon the plan pro-
posed by M. Griesinger. We have not these examples of nervous disorders in
general, but only cases of hysteria and epilepsy.

M. Laseque. — Since I have been called upon to give a course on insanity at
the Faculty at Paris, I have adopted a mixed plan. I have received some cases
of lunacy in my wards. I have been compelled to admit only quiet cases> and

424 Notes and News. [Oct.,

conseqaently the scheme is incomplete ; but restricted as we are by laws and
rules, it cannot be otherwise. The institution of a small asylam in the imme-
diate contiguity of an hospital does not appear to us as likely to be attended
by good results. The proposition of M. uriesinger is a most interesting one;
it is of undoubted advantage, both to teacher and taught, to have affections
brought together which have so many points of contact, but we are unfor-
tunately so placed that we cannot copy the institution recommended.

M. Grietinger in conclusion replied that he had not a discussion in view in
reading his paper, his purpose being simply to state what he had done, and to
discover that his plan was approved iu the interests of science.

M. Lambroso^ of Pavia, communicated a series of meteorological observations,
from which the conclusion seemed to fullow that variations in atmospheric
pressure exerted a marked influence on the number and violence of the convul-
sive seizures of epileptics and of the paroxysms of excitement of maniacal
patients. The influence, moreover, of ozone and electricity, and of the
wind, is much marked, and that of the moon even more so, for the greatest
number of paroxysms and fits correspond with a new moon.

The seance terminated after an address by M. Morel, who proposed a vote of
cordial welcome to the distinguished strangers who had honoured the invitation
of the Society.

A banquet followed after the close of this seance^ at which toasts were pro-
posed by MM. Janet, Brierre de Boismont, Griesinger, Morel, Las^que, Har-
rington Tuke, Pujudar, Deiasiauve, Cerise, Motet, and Linas.

The following seance took place on August 14th, under the presidency of M.
Brierre de Boismont. The same foreign physicians, with the addition of Dr.
Bucknill, and M. Bachel, of Venice.

M. Lunier completed the reading of his essay on comparative legislation.

He also announced that the labours of the commission appointed to prepare
a general scheme of statistics, applicable to all countries, had so far advanced
that it would be possible to forward a copy of proceedings to all the members,
so that such observations as might at the time have escaped unheeded might
be brought forward, and a general agreement on all points be thus attained.
The tables forwarded will, after their revision, be returned to Paris and defi-
nitely adopted.

M. Borrel presented plans of a pavilion suited for four patients aud the
residence of an assistant physician, as carried out at the asylum of Trefargier,
in the Canton of Neufchatei, Switzerland.

M. Berstrier read a paper on the basis of a new general scheme of statistics,
to which M. Lunier replied.

M. Brierre de Boismont next addressed the meeting to the following effect :
It was my purpose to address you on our intervention in judicial matters, but
I do not aesire to inflict upon you a collection of all the facts I have had
under my notice during a career of considerable length. All, however, tiiat I
can now say is, that we are called upon to render important services both to
families and to magistrates ; the knowledge acquired by us respecting mental dis-
order makes us competent to give our advice and opinion in this delicate question.

At the termination of the day's proceedings Dr. Tuke asked permission to
address a few words to the Society :

Mr. President and Gentlemen, — I can but imperfectly speak your language,
but I cannot refrain, before we separate, making an attempt to express my
feelings of gratitude to you, Mr. President and gentlemen, whom I have the
honour of regarding as my confreres and fellow-workers. I thank you sin-
cerely for the hospitality you have shown to us foreign visitors in so cordial a
manner. On my part I siiould be happy to give you as hearty a reception in
London as tiiat which we have here received from you.

1867.] Notes and News, 425

The Asylum Cottage at the Paris Exhibition,

One of the most interesting objects which is to be seen at the great show
on the Champ de Mars, and one which must possess pecaiiar attractions to
members of our profession, is the beautiful little cottage which is exhibited by
Baron Mundy. It is situated in a prominent part of the Austrian section of
the space external to the great building. The various gables with their over-
hanging eaves give a comfortable homelike aspect to the cottage, which is en-
hanced by the pretty little garden-plot in front. On the walls of the two
principal apartments are displayed large plans and drawings illustrating the
system of colonisation which Baron Mundy specially advocates.

According to his idea of a model asylum, the majority of the patients should
be accommodated in groups of five in the houses of married attendants, and
each group of fiye such cottages should be under the supervision of a head
attendant. A coloured drawing, which is hung on one of the walls, represents
the arrangement of buildings for an asylum to accommodate 300 patients.
Oue half would be provided for in a central hospital, and the other half would
reside in the cotts^s. In the centre are situated the hospital, the buildings
connected with general superintendence, the chapel, and the residence of the
medical su})erintendent, which is intended also to accommodate forty higher
class patients. The surrounding space is occupied by the cottages and their
seversd patches of farm or garden. There are also residences for their
assistant medical officers, who, like the medical superintendent, are expected
to receive private patients, though in much smaller number. The extra
mural portion of the colony would thus consist of thirty ordinary cottages,
each containing an attendant, his familv, and five patients ; six cottages for
head attendants, in which patients would only be temporarily accommodated,
the usual village workshops and stores, and the residences of three medical
men. The quantity of land which is proposed as sufficient for the requirements
of the system is 100 hectares ; and Baron Mundy estimates that the average
price of suitable land would be about 2000 francs the hectare, or £8000 for
the whole, and that 1,000,000 francs, or £40,000 would cover the expense of
everything. The original expense per head would thus be about £133. The
expense of management would, however, according to the Baron's estimate, be
a very slight burden upon the public.

The model cottage which is exhibited illustrates what is proposed as the
residence of a heaa attendant. It consists of two parts, one in which the
family of the attendant would reside, and consisting of a parlour, bedroom,
and kitchen, the other would be kept for patients, and consists of bedroom,
bathroom, and padded room. It is probable that the latter half of the house
would only be occasionally inhabited, as it would be chiefly used as a temporary
abode for new cases, where they might be watched prior to removal to their
more permanent home. It would also be useful on occasions where more
than ordinary difficulty might be experienced in treating any case in a neigh-
bouring cottage.

The rooms of the cottage are furnished in the manner of south Germany,
and are models of neatness. The walls are covered with plans and drawings
illustrative of Baron Mundy's views. Among others a large map of the
commune of Gheel may afford useful information to many visitors. The space
which is not occupied by maps and drawings is devoted to quotations from
sixteen different authors who have written about the colonisation of the insane,
or on subjects bearing upon their treatment. The following may be taken as
examples :

426 Notes and News, [Oct.,

((I

The reform gloriously begun by Pinel is still incqmplete, in so far as
sequestration oversteps the necessary req[uirenients of public security. The
insane person is not really treated as a patient ; he remains a prisoner suffering
from disease." — Jules Duval, GheeL

** The system to be employed in future in the treatment of the insane is in-
contestabfy the family system." — P&ofessob Griesingeb.

*' I say, and I repeat what I said fifteen years a^, there is no asylum which
is worth a good colony, and there is no country m which the insane may not
be colonised." — M. Moeeau de Toubs.

We have much pleasure in noticing this contribution to philanthropy ; for,
whatever may be ttie differences of opinion among us as to the best mode of
providing for the insane, none can help admiring the disinterested devotion
which has prompted Baron Mundy to spend so much time, money, and kbour,
in advocating wnat he believes to be for the good of the insane.

An Unlicensed Asylum at Aldringham,

{Suffolk Summer Assizes, 1867.)

Fkbdebick Willis Hone Milbubn was charged with having received
James Alexander Barnes and boarded and lodged him as a lunatic at his
house, at Aldringham, without having the necessary licence authorising him
to do so.

Mr. O'Malley and Mr. Metcalfe appeared for theprosecution ; Mr. Milburn
was defended by Mr. Nay lor, instructed by Mr. H. K. Moseley.

Mr. CfMallr^y in opening the case, said the prosecution was instituted by
the Commissioners in Lunacy. In former times there were facilities for
shutting people up in asylums, and they could be kept shut up ; but the law
now provided that people of unsound mind should be kept in places to which
the Commissioners in Lunacy should always have access, in order that they
might, by periodical visits, satisfy themselves that the patient was a fit person
to be an inmate of a lunatic asylum. It was of the utmost importance that
a lunatic should be kept in a place where others besides the private medical
man, who might be consulted by the parties who sent the lunatic, could see

* In his charge to the grand jury the Lord Chief Justice made the following
observations on this case : —

" There is one more case of considerable importance, and that is the case of
Mr. Milburn, who is indicted for receiving a lunatic not having complied with the
Act. You are aware that the law is stringent on this point, and that there are
Acts of Parliament which make it penal to receive a person who is a lunatic into
any hospital, or any place not licensed, or without a certificate of a medical man
certifying that the patient is insane, such law being necessary for the protection of
those who are lunatics, and also for those who are not ; in order that those who are
not lunatics may not be subjected to durance. It is also necessary in order that those
persons who have the misfortune to be insane may have all tne protection given
them which in point of law the legislature has wisely provided for them ; there-
fore, if it should be proved to your satisfaction that the defendant has received a
patient without complying with the Act of Parliament, it will be your duty to
send up the bill. It may turn out that the party has been properly treated, but
even in that case it will be your duty to find a true bill ; for this law provides that
certain requisitions shall be satisfied and certain formalities complied with as con-
ditions precedent to the admission of any person into a lunatic asylum, and there-
fore if it turns out that this man was received without certificates, and into a
place not licensed as the law requires, the keeper of the house will be liable to the
penalties of the law upon the facts being proved.''

1867.] Notes and News. 427

him in order that they might from time to time ascertain not only what was
the treatment he experienced, but also how far the state of his mind justified
the use of restraint. It was^ of all things, a question of importance with
reference to property. Under the old system, a man might be shut up with-
out any one having the power to examine him. It might, and it did, occur
that a man would be shut up in a lunatic asylum and restrained or coerced in
the exercise of all his rights with regard to his property, for the purpose of
being kept qut of the way, and kept from receiving his property. No one in
such cases was aware that such a man was a lunatic, and yet his rights were
all invalidated by reason of his supposed lunacy. These evils were of the
greatest and the most crying character, and by a series of Acts of Parliament
It was provided, he thought he might say as far as human foresight could
provide, that the medical and domestic care of lunatics should be oi a proper
character. Means were taken for giving people access to lunatics, and the
Commissioners were charged with the protection of the lunatics, and their
duty was to see how they were treated from time to time in order to guard
against the evils to which he had alluded. Certain things were necessary
before lunatics could be confined. If more than one patient was confined in
a place a licence from the Commissioners or from tne magistrates was re-
quired, but where only a 1 single lunatic was confined the licence was dis-
pensed with; but it was provided by 8 & 9 Vic, c. 100, sec. 90, that no
person, unless he be a person who derived no profit from the charge, should
receive, or board, or lodge in a house other than an hospital registered under
that Act, or take charge or care of any patient or lunatic, or alleged lunatic,
without a similar order to that which was required for a regular asylum or
licensed house ; and every person who might receive such a person was re-
quired, within seven days, to transmit to the Secretary to the Commissioners
in Lunacy a true and perfect copy of the order and medical certificates on
which the patient had been received, and every person not complying with
the terms of this Act was to be guilty of a misdemeanor. The learned
counsel then quoted the remaining portions of the Acts relating to the de-
tention of lunatics, and said he must say, although he was reluctant to say
anything harsh of a man in the predicament of the defendant, that the case
was one of a very aggravated character. Here was a man who called himself
— he said called himself, for they had no knowledge whatever of the fact — a
medical man, but he signed himself M.D. in his communications, and who
stated that he had been engaged in the same business for some years. They
did not know what was his history in that respect. But in the year 1860 he
was living in London, and at that time the Rev. James Barnes — a brother
of a gentleman they all knew, one of the partners of the firm of Lyon, Barnes
& Co. — a man of considerable attainments, a fellow of Trinity College, Cam-
bridge, unfortunately became insane, and negotiations took place between
Mr. Barnes (the brother of the Rev. James Barnes) and his wife and the
defendant (Mr. Milburn), for the reception of the patient, and he would read
two or three of the letters which passed between the parties, because they at
once established the greater part of the case against the defendant. These
letters proved that Mr. Milburn received Mr. Barnes as a lunatic, that he
took charge of him as a lunatic, that he did this for hire ; for the letter ac-
knowledged the receipt of moneys equivalent to somewhere about £500
a year. The letters also proved incontestably that the defendant had know-
ledge that he was doing that which was contrary to the law ; and the other
parts of the case would be supplied by the testimony of witnesses which he
would call. Shortly after these letters had passed, the patient was brought
down and put under the care of Mr. Milburn, who had removed to Aldring-
ham^ in this county, a very remote and lonely place, and there for several
years Mr. Barnes had continued under the care of Mr. Milburn ; and some

428 Notes and News. [Oct.,

short time ago the attention of the Coinmi^sioners was called to the fact, and
they found Sir. Milburn, a gentleman of education and experience in such
cases, and one who must hare had a knowledge of the unlawfulness of what
he had been doing, and that it was a complete violation of the law ; and the
Commissioners, in the discharge of their duty, brought him there to be tried
by his Lordship and a jury. Mr. 0*MalIey then read a series of letters, the
first dated April I7th, 1860, in which Mr. Milburn said, ''In respect to
your advertisement in this day's ' Times,' 1 beg to submit the following
remarks to your notice. I have practised as a physician, exclusively in
mental diseases, for twenty years, and during some period of that time I was
connected with the management of a public institution. I should receive a
single patient in my family — for I have now ceased to practise generally—
and will confine my attention to one resident patient. The gentleman at
present with me is about to resume the control of his own affairs, after many
years of personal restraint." That letter showed that the defendant had
for a great manv years had another patient, under similar circumstances to
those under which he had taken Mr. Barnes under his care, and that
be was receiving Mr. Barnes as a lunatic, because he referred to
the friends of persons who been under his care. Mr. O'Malley then
read a letter, dated May 21st, in which Mr. Milburn stated that the terms
under which he had received and treated his last patient were £400 a year,
and that he had told the brother of his correspondent, Mrs. Barnes, the wife
of the patient, that he hoped £500 a year would not be deemed more than
sufficient, but that he was willing to leave the matter in his (Mr. Keith
Barnes's) hands. Another letter, dated June 18th, 1860, was also read, as
follows : " Dear Sir — I have been almost daily expecting the 'performance of
your promise to write me a letter of indemnity for the possible consequences of
detaining the Rev. J. C. Barnes, and such a one also as I might show when
it might be necessary to restrain him, should he succeed in his constant en-
deavours to leave us." By the provisions of the Act of Parliament, which
seemed to have been present to Mr. Milburn's mind, an indemnity was pro-
vided for this very case. Sec. 90 provided that where proper certificates
were given, and the proper preliminary course taken, a complete indemnity
was furnished, not only for receiving the patient, but also an authority to re-
arrest him, and a justification for re-taking him in case he escaped. The
provisions of the 99th sec. were, in fact, exactly what the defendant required
in the letter. He would request his learned friend, Mr. Naylor, to furnish
him with a letter written on the 5th of June. [The letter was handed io,
and read by Mr. O'Malley. It was a formal request by Mr. Keith Barnes
that Mr. Milburn should take charge of his brother, the Rev. James Alex-
ander Barnes, who was a person of unsound mind.]
Mr. Naylor said the words in the original letter were " mental imbecility."
Mr. CfMalley said that made no difference ; for, by the construction of the
Act, imbecile persons were considered as lunatics. Mr. O'Malley then
quoted the remaining portion of the letter, stating that Mr. Barnes was
generally conscious of his own incapacity to take care of himself, and he (the
writer) had no reason to believe that he would attempt to leave Mr.
Milburn's house ; and that, if he should do so, that letter might be shown as
an authority for restraining him ; and if the patient should become insane,
the same end would be accomplished by the usual medical certificate. This
letter the learned counsel said made the case much worse than it had appeared
at first ; for that letter, which seemed like a guarantee to Mr. Milburn, was
not sufficient, and he asked for something more in the letter, which was read
previously. No one could read those letters without knowing that Mr.
Milburn was, with his eyes open, violating those laws which had been esta-
blished for the protection of lunatics. He would put in another letter,

1867.] Notes and News. 429

dated January 18th, 1865, which would prove not only that Mr. Milburn
did receive the patient as a lunatic, but also that he did acknowledge his
liability. The letter was directed to Mr. Keith Barnes, and one paragraph
was as follows : " In further reference to the purchase of furniture for Mr.
Barnes, it may be as well to observe that it would relieve me of some
anxiety in respect to the possibility of my being troubled for not having Mr.
Barnes under certificate of the Commissioners in Lunacy ; for a person, how-
ever insane, may legally, under proper guardianship, remain in his own
house." The words " own house" were underlined, and that pointed out that
it was intended for Mr. Barnes to become the owner of the house, and that
Mr. Milburn was to take charge of him in his own house, and that for the
expressed object of defeating the provisions for the protection of lunatics.
Mr. O'Malley then indicated the evidence he was about to call in support of
his opening. The Clerk from the office of the Clerk of the Peace for the
County would prove that no licence had been granted to the house, and the
Clerk to the Commissioners in Lunacy would prove that no certificate had
been taken there, and the inference would be that none had been obtained,
as by law be was bound to produce to the Commissioners any certificate.
He would also call a medical man who had seen Mr. Barnes to prove that he
was undoubtedly insane. The following evidence was then called :

Mr. John D. Cleaton said — I am one of the Commissioners of Lunacy. In
consequence of a communication which I received, I visited Aldringham
House in July. Mr. Lutwidge, another Commissioner, also went with me.
We called to our assistance Mr. Freeman, a medical gentleman from Sax-
roundham. Almost the first person we saw was Mr. Barnes himself. The
door was open, and there was no servant about, and Mr. Barnes came down
stairs. He appeared to be between 60 or 70 years of age, and rather infirm.
He appeared reluctant to enter into conversation in the house, and begged
us to go into the garden. We had a long conversation with him in the
arbour in the garden. From the conversation I inferred that he was in a
most distressing state of insanity, most unhappy, and labouring under various
delusions.

Cross-examined. — I believe Mr. Barnes had been out for a drive. I did
not ascertain that a little girl, Mr. Milburn's daughter, had driven him out.
We have no reason to believe that Mr. Barnes was other than well treated.
I believe the communication did not come from any of Mr. Barnes's family.
I cannot say from whom it did come. I received my orders from the Board.
Mr. Lutwidge had seen Mr. Barnes before; they were old college friends.
I did not hear any remark made by Mr. Lutwidge to the effect that he was
especially satisfied with Mr. Barnes's appearance.

Mr, Naylor. — Was there not a groom and carriage kept for Mr. Barnes ?

Witness. — I don't know.

His Lordship said there was no question raised as to the treatment of the
patient ; and, however well he might have been treated, the offence of keep-
ing him there was just the same.

Mr. OMalley. — Do you think that gentleman was in a state to transact
business ?

Witness. — Certainly not.

Mr. Alfred Barnes^ nephew of the patient, was next called, and said : Within
three or four years I have got my uncle to sign deeds. I have not been
there since 1864. I used to visit nim frequently at Mr. Milburn's.

His Lordship. — Signing deeds has nothing at all to do with the case.
When did you last see him do this ?

Witness. — I do not know.

Do you think he has been insane since 1858 ? — He was restless and ex-
citable.

430 Notes and News, [Oct.,

Cross-examined. — I always stayed anight or two when I came down. I may
have taken deeds for him to sign more than twice, but I cannot exactly say
how many times. My uncle was living in the greatest comfort, and treated
as a gentleman ought to be. Mrs. Barnes, his wife, frequently visited him,
and stayed with him, and her letters were full of expressions ox thankfulness
at his treatment.

Re-examined. — I believe £500 a year was paid at first, and after that it
was increased to £600, besides clothes.

Mr. Freeman^ surgeon, Saxmundham, said, I saw Mr. Barnes at Aldring-
ham, and I am of opinion that he was insane. I had been at the hoose
previous to the visit with the Commissioners. The first time I saw Mr.
Barnes was about 1861. He was insane then. I cannot say how many
times I have seen him since.

Mr. Albert Barnes was recalled to prove that the letter of the 17th of
April had been taken from his uncle, Mr. Keith Barnes's papers, that letter
not having any marks upon it to show that it had been addressed to that
gentleman.

The letters which had passed between the defendant and different mem-
bers of Mr. Barnes's family were formally and fully read by the clerk. They
were substantially the same as quoted by Mr. O'Malley in his opening, but
there were a few particulars relating to the family and position of tbe
defendant which had not been read.

His Lordship asked if the Act of Parliament gave any authority to a
person to act under such a letter of indemnity as had been spoken of in tbe
correspondence.

Mr. CtMalley. — No, my Lord; the 90th section provides tfiat very in-
demnity.

John Goldsmith, from the office of the Clerk of the Peace for Suffolk, was
called to prove that no licence had been granted to Mr. Milburn by the
magistrates.

Thomas Martin, Chief Clerk to the Commissioners of Lunacy, also proved
that no order or certificate had been received at the office in respect of the
Rev. Mr. Barnes.

Mr. (/Malley called the attention of his Lordship to sec. 90 of the Act 17 and
1 8 Vic, the schedules of which required the same certificates in the case of a
person who resided in a private house, as required by the Act of Parliament
for persons residing in asylums. With respect to the proofb of the insanity
of Mr. Barnes, the interpretation section said that a lunatic should mean
every insane person, lunatic, imbecile, or idiot, or person of unsound mind.
The letters which had been read, especially that one endeavouring to get the
guarantee, clearly showed that the defendant knew that the law r^arded
the patient as a lunatic. This case furnished a striking instance of the
dangers from which the law intended that persons of unsound mind should
be protected. Here they had the counsel for the defendant himself, bringing
forward the fact that the patient had transacted business, and signed deeds,
for the purpose of proving that he was not insane.

Mr, Naylor said the terms of the Act were against receiving any lunatic,
or person of unsound mind, and that at the time Mr. Barnes was received
by Mr. Milburn there was nothing to show that he was insane.

His Lordship. — There is the evidence of the letter in reply to the advertise-
ment in 1860, and there is a letter written in June the same year, saying
that he was in dail^ expectation of an indemnity against the possible con-
sequences of detaining Mr. Barnes.

Mr, Naylor called his Lordship's attention to the passages in the letter
speaking of the patient's mental imbecility, and saying that he had a general
sense of his inability to take care of himself. There was no doubt that Mr.

1867.] Notes and News. 431

Barnes's friends anticipated that he might become a lunatic ; but there were
no expressions in the letters to show that he was a lunatic then.

His Lordship, — We have evidence that he was a lunatic in 1861. And in
the answer to the advertisement in the ' Times ' the defendant himself treats
the case as one of lunacy, and not merely of incapacity.

Mr. Nay lor. — Mr. Keith Barnes does not treat it in his letter as a case of
lunacy.

His Lordship. — He was in a state of mental imbecility.

Mr. Naylor, — His age would account for that.

His Lordship. — He was between fifty and sixty years of age, I believe. I
hope that will not be the fate of all of us at that age. (Laughter.)

Mr. Naylor said that his instructions were to have the case gone into, and
also to put forward that the patient had been well treated.

His Lordship. — It is not suggested that this unfortunate gentleman has
not been treated with every kindness by Mr. Milburn ; but still there is the
law, and it must be respected, and what has been brought out shows not
only that the law has been violated, but violated by Mr. Milburn with per-
fect knowledge of what he was doin^.

Mr. Naylor said his Lordship took a hard view of the matter. Mr. Mil*
burn regarded it as a case of mental imbecility.

His Lordship. — But he asked for an indemnity against the consequences of
taking Mr. Barnes.

Mr. Naylor called his Lordship's attention to an expression in a letter
from Mr. Keith Barnes, ** if necessary you shall be supplied with a certi-
ficate." The subsec[uent letter of Mr. Milburn seemed to have been an
application for a certificate. After Mr. Milburn found that the patient was
a lunatic he tried to get a certificate.

His Lordship. — He did not get it, and yet he goes on to treat him as
a lunatic.

Mr. Naylor submitted that Mr. Milburn had all along seemed to treat him
as one who was not a lunatic.

His Lordship. — Mr. Keith Barnes put him into the hands of this gentle-
man, and there is no doubt that he was a lunatic. Mr. Freeman saw him
frequently.

Mr. Naylor said after his Lordship's communication he did not think it
would be of any use to address the jury.

His Lordship. — If you do I shall certainly direct them as to their verdict.

Mr. Naylor said he should advise the defendant to withdraw his plea and
throw himself upon his Lordship's consideration.

Mr. CfMalley said the proceedings had merely been undertaken in vindi-
cation of the law. This case had gone on for five years, and there might be
many others for all the Commissioners knew. Their object, of course, was to
prevent the repetition of such offences.

Mr, Naylor. — Your Lordship will also remember that the family of Mr.
Barnes has taken no part in this.

Mr. O^Malley. — The duty of the Commissioners is to protect men from
their families as well as against the keepers.

His Lordship said there was no question about the lunacy, and there was
no doubt that the family did place Mr. Barnes with Mr. Milburn with a
view to his being taken care of. Mr. Milburn had not taken care to comply
with the proper restrictions, and he (the learned Judge) must pass such a
sentence as would have effect of deterring anybody else from violating that
which, taken on the whole, was a most salutary provision, and one which
must be enforced. The jury must find a verdict of guilty. The letters
which had been read showed plainly that the unfortunate gentleman was
received as a lunatic, and therefore he needed the certificates that the law

43 :J Notes and News, [Oct.,

requires. These things were for the protection of those who were not
lunatics at all — persons who might be imbecile to a certain extent — to pre-
vent their being shut up from sinister or unworthy motives. Such things
had been done, and the laws now put in force had been enacted to
prevent them. He trusted they would continue to have the desired
salutary effect. The jury would, therefore, say that the defendant was
guilty of detaining Mr. Barnes without being properly and legally quali-
fied to do so.

The jury immediately returned a verdict of guilty.

His Lordship t in sentencing the prisoner, said, he must pass such a
sentence as would meet the justice of the case; no doubt Mr. Milburn
had violated the provisions of the statutes, which he (the learned
Judge) considered essential for the protection of lunatics, as well
as to prevent such persons as were only in a partial state of mental
aberration being treated as lunatics. The family of the patient appeared
satisfied with the care and attention which he had received, still he (the
defendant) had broken the law. He did not think it necessary to pass a
sentence of imprisonment, but such a fine as would be sufficient to teach
him and everybody else that the laws must be respected. The sentence
was that the defendant pay a fine of £100 to the Queen, and that he
be imprisoned till such fine be paid. His Lordship immediately added
that he had no wish to subject Mr. Milburn to imprisonment if he was
not prepared at the moment to pay the fine. If he would enter into
recognizances to pay it the next day, or before the Court rose, it would
be sufficient.

Mr. Naylor asked to have three days allowed.

His Lordship. — I hope to have finished to-morrow ; but I will allow such
time as it may take my learned brother to finish the case in the other court.

[On Wednesday morning his Lordship had the defendant called, and also
the learned Counsel for the prosecution, and said, upon reconsidering the
mutter, he had resolved to fine Mr. Milburn £50, and require him to enter
into recognizances not to repeat the offence. The recognizances were fixed
at £300.]— /jP5«?tM Journal^ August 17th, 1867.

Statistics of Suicide.

The death registers show few, if any, items more remarkable for the
constant ratio of their occurrence than the regularity with which suicide
counts its victims. In this country, year after year, more than 1 ,300 men
and women, driven to desperation by their own folly or by some over-
whelming misfortune, seek refuge from trouble in death : some of these — it
is not recorded how many — belong, of course, to the class of irresponsible
beings whose deficient mental organization incapacitates them from being
safe custodians of their own lives. The statistics of suicide in England,
according to the Registrar-General's returns, show that the annual propor-
tion to every million of the population has ranged in the eight years from
1858 to 1865 successively thus:— 66,64, 70, 68, 65, 66, 64, 67. With two
exceptions, therefore, the last state of things is worse than the first. No
account is kept of the attempts which are frustrated, so that there is
nothing beyond surmise to give any tilue to the probable movement of the
tendency to suicide among us. It is, however, certain that the figures we
have quoted above do not fully represent the extent of the crime, inasmuch
as some — no one can possibly know how many — of the deaths by drowning
and other means must be set down to self destruction. The extraordinary

1867.] Note^ and li'ews. 433

regularity with which the same means are employed for the same end is not
the least curious feature in these statistics. Hanging has always been the
mode most commonly adopted, and 28 out of the ratio of 67 per million
suicides of 1 865 fall under this head, the proportion haying remamed almost
constant in successive years. Cutting or stabbing and drowning, accounting
for an [almost equal proportion (12 and 11 out of the 67 per million), come
next in the order of frequency ; then follow poisoning (7) and gunshot
wounds (3), the residue (6) not being specifically described. The ratio of
suicides by means of firearms was 3 per million in each one of the^ eisht
years, and the other ratios show little or no variation. Dr. Young, in his
' Night Thoughts,' speaks of '* Britain, infamous for suicide ;*' and, judging
from a recent comparison in a French statistical journal, we still maintain a
very unsatisfactory position as regards some other European states. The
ratio of suicides per million of the respective populations m 1864 was 110 in
France, 64 in England, 45 in Belgium, 30 in Italy, and 15 in Spain. This
must of course be taken cum granoy as, notwithstanding the efforts of statis-
tical congresses, international comparisons are still surrounded with great
uncertainty. — Fall-Mall Gazelle,

Publications, ^c, Received, 1867.
{Continued from the 'Journal qf Mental Science* July, 18670

* On Pain, and other Symptoms connected with the Disease called Hysteria.*
By Dennis De Berdt Hovell, M.R.C.S., Vice-President of the Hunterian
Medical Society. London : John Churchill and Sons, 1867, pp. 44,

'The Insanity of Pregnancy, Puerperal Insanity, and Insanity of Lactation.*
By Dr. J. B. Tuke.

(Reprint Jrom * Edinburgh Medical Journal/)

* Trousseau's Glmical Medicine.' Translated and Edited, with Notes and
Appendices, by the late P. Victor Bazire, M.D. To be completed in 12 Parts,
demy 8vo. Part III. — 18. Cerebral Rheumatism; 19. Exophthalmic Goitre;
20. Angina Pectoris ; 21. Asthma; 22. Hooping Cough; 28. Hydrophobia.
London : Hardwicke, 192, Piccadilly.

Arrangements for the continuation of the translation oj this valuable leork are
in progress.

* A Practical Treatise on Shock after Sargical Operations and Injuries : with
Especial Reference to Shock Caused by Railway Accidents.' By Edwin
Morris, M.D. London : Robert Hardwicke, 1867, pp. 88.

* De la Eolie Raisonnante et de I'lmportance du D^lire des Actes pour le
Diagnostic et la M^decine Legale. Par A. Brierre de Boismont. Paris:
J. B. BaiUi^re et Fils, 1867. (See Part 11, Reviews,)

' A Preliminary Notice of the Akazga Ordeal of West Africa, and of its
Active Prmciple.^ By Thomas R. Frasei, M.D., F.R.S.E., Assistant to the
Professor of Materia Medica in the University of Edinburgh. London:
Printed by J. E. Adlard, Bartholomew Close, 1867 {pamphlet).

(Reprinted from the * British and Foreign Medico-Chirurgical Review^* July^
1867.)

VOL. XIII. SO

434 Note9 (md News, [Oct.

« Die Lehre yon der Tabes Dorsoalis, Kritisoh and Ezperimentell Erl&utert.'
Yon Dr. E. G^on. Berlin : Yerlag von Carl Sigism, Lieorecht, 1867, pp. 115.
Ah itUereattng manoffraph, and care/ulfy worhsd up.

* Esquisses de Mdd^cine Mentale : Joseph Gablain sa vie et Ses ficrits.' Par
A. Brierre De Boismoni, Doctor en M^decine, Membre Tiiolaire de la Soci6t6
M^dico-Fsychologique de Paris, Membre Correspondant de TAcad^mie Hoyale
de M^^cine de Belgique, et de la Soci^t^ des Sciences M^dicales et Naturdles
de Braxelles. Avec le portrait De Gmslain. Paris : Germer Bailli^re,
Libraire-Editeur, 1867, pp. 160.

' Gheel on Une Colonic D'Ali^n^s, Yivant en Famille et en Libert^ Etude
sur le Patronaffc EamUial Appliqne an Traitement des Maladies Mentales Avec
nne Carte de la Commnne ae Gheel.' Par Jules Duval, Ancien Magistrat,
Yice-Pr^ident de la Commission Centrale de la Soci^t^ de G^gn^hie de
Paris, Directenr de Tficonomiste Eranpais. Paris, 1867, pp* ^0.

A moii intereiting utay,

'Studies: Biographical and Literary. By George Bx)ss, M.D. SimpkiQ)
Marshall, & Co., pp. 168.

Appointments.

J. 0. Adams, M.It.C.8.E., has been appointed Assistant Medical Officer at
the City of London Lunatic Asylum, Stone, Kent.

J. EdmundsoD, M.D., of the Clonmel Auxiliarv Lunatic Asylum, has been
appointed Eesident Medical Superintendent of tne District Lunatic Asylom,
Gastlebar, Co. Mayo, vice T. C. Burton, M.D., resigned.

G. Thompson, M.K.C.S., has been appointed a Resident Clinical Clerk in
the West Hiding Lunatic Asylum, Wakefield.

T. B. Pattinson, M.E.C.S.E., has been appointed Assistant Medical Officer
to the Cornwall County Lunatic Asylum, Bodmin.

Obituary.

On the 5th of July, aged 83, died William Lawrence, E.E.S., Surgeon to
Bethlehem Hospital since 1815, and an Honorary Member of the Medico-
Psychological Association.

'* Latcrence (sojfs JBrodie, in his autobiography) was one who has since aegtdred
so large and well-deserved a reputation. He was even then (1801 P) a remarkable
person, 1 never knew any one who had a greater capacity for learning than he
had, nor more industry, nor who at the same age had a greater amount of inform'
ation — not merely on matters relating to his future profession^ but on a great
variety qf other subjects. From that time to the present, Lawrence and myself
have been moving in parallel lines, he having had the largest share of private
practice next to myself; and it may be regarded as somewhat to the credit of both
of us that there has never been any manifestation of jealousy between us, I have
already mentioned that when a young man he had some faculties in great per*

1867.] Notes and News. 486

feeiion^ and he has them still, and but little, as far as lean see, impaired by the
addition of ffty years to his age* He has a great memory, and can easily recur
to and make use of what he knows. He has considerable powers of conversation,
but without obtruding himself to the exclusion of others^ as is the case with too
many of those who are reputed to be good talkers. What he says is full of happy
illustrations, with, at times, a good deal of not ill-natured sarcasm. In public
speaking he is collected, has great command of language, and uses it correctly, but
not equal to what he is in ordinary society. In writing, Bs style is pure, and free
from all affectation, yet in general not sufficiently concise. His reading has been
extensive ; he is well acquainted with modem, and moderately so with the ancient,
languages. His professional writings contain a vast deal qf information, but it is
more as to what he has taken from other authors than as to the result of his own
experience and observation. That he is thoroughly acquainted with his ownpro^
fession cannot be doubted, for it would not have^^een jpossible for him otherwise to
retain for so long a period the high place which he has occupied,"

On the 22nd July, at Moororoft, Hillingdon, Middlesex, died George J.
Stilwell, M.D., eldest son of 6. StUwell, Esq., Epsom, Surrey, the beloved
Physician to the establishment. The loss which the medical profession, and
especially the psychological branch of it, has sustained in the premature death
of Dr. George Stilwell, is one which will not be easily replaced. At an early
age he was suddenly called upon to fill the place of one who occupied a promi-
nent position in his ph)fe8sion, and most worthily and honourably has he ac-
quitted himself and maintained the reputation already belonging to the honoured
name he bore. His modest and gentlemanly bearing was combined with an
excellent disposition and good sound common sense, and won for him the good
opinion and confidence of all who knew him ; while those of his own profession
who were brought in contact with him felt that they were dealing with a
thoroughly upright man, upon whose opinion they could rely and in whose
hands tiiey were safe.— ^nVt^A Medical Journal, August 10.

Notice to Correspondents.

English books for review, pamphlets, exchange ioumals, &c., to be sent either
by book-post to Dr. Eobertson, Hayward's Heath, Sussex ; or to the care of
the pubhshers of the Journal, Messrs. Churchill and Sons, New Burlington
Street. French, German, and American publications may be forwarded to
Dr. Eobertson, by foreign book-post, or to Messrs. Williams and Norgate,
Henrietta Street, Covent Garden, to the care of their German, French, and
American agents, Mr. Hartmann, Leipzig; M. Borrari, 9, Hue de St. F^res,
Fans ; Messrs. Westermann and Co., Broadway, New York.

Authors of Original Fapers wishing Eeprints for private circulation can have
them on application to the Printer of the Journal, Mr. Adlard, Bartholomew

436 Notes and News, [Oct.,

Close, E.C., at a fixed charge of 30«. per sheet per 100 copies, including a
coloured wrapper and title-page.

The copies of The Journal of Mental Science are regularly sent by Book-pat
(prepaid) to the ordinary Members of the Association, and to our Home and
^reign Correspondents ; and Dr. Robertson will be glad to be informed of ajiy
irregularity in their receipt or overcharge in the Postage.

The following EXCHANGE JOURNALS have been regularly received since
our last publication :

The Annates MSdico-Psychologiques ; the Zeitschrift fur Psychiatrie ; the
Correspondenz Blatt der deutschen Gesellschaft fur Psychiatrie ; Archiv fur Psy-
chiatric ; the Irren Freund; Journal de Medecine Mentale ; Archivio Italiano
per le Malatlie Nervose e per le Alienazioni Mentali ; Medizinische Jahrlmcher
{Zeitschrift der K, K, Gesellschaft der Aerzte in Wien) ; the Edinburgh Medical
Journal; \he American Journal of Insanity ; the Quarterly Journal of Psycho-
logical Medicitte, and Medical Jurisprudence, edited by William A. Hammond^
M.D, {New York) ; the British and Foreign Medico-Chirurgical Review ; the
Dublin Quarterly Journal; the Medical Mirror; the British Medical Journal;
the Medical Circular ; the Journal of the Society of Arts ; and New York
Medical Journal, Also the Momingside Mirror; the York Star ; Excelsior^ or
the Munay Royal Institution Literary Gazette.

On and after the 1st of October great facilities are given for the transmissioa
of periodicals between England and the United States of America, by Book Post.
We trust our American Correspondents will avail themselves of them.

We have also received the County Union .and AngUhJamaican Advertiser,
June 7.

Press of matter compels us to defer the insertion of an able analysis (witli
remarks) of the recent Act of Parliament relatmg to the Irish District Asylum.

Dr. Alexander Robertson, of the Town^s Hospital and Asylum, Glasgow, lias
sent us a specimen of a very clever screw button for fastening dresses, and
which will probably supersede the old Hanwell pattern. Dr. Alexander
Robertson will be glad to communicate with any member of the Association
who may wish a copy.

(Vo. 64. Hew Series, No. 28.)

THE JOTTBHAI OF HEHTAL SOIEHCE, JAHTTAST, 1868.

[Pvhluhed by autkorily of the Medieo-Pmfchologieat Jaociation.']

■iirt'.

Iff """

CONTENTS.

^A*0^J^^*^*^*^t^^^^

S^i^>^^^^m

PART I. -ORIGINAL ARTICLES.

PAGE

So1)ert Donii, F.S.C.S. — Some Observations on the Phenomena of Life and

Mind ......... 437

The State of Lunacy in 1866 (Great Britain and Ireland) . . . 449

Arthur Ktehall, K JL and MJ>. Abdn., T.B.8.S., &c.— >The Care and treat-
ment of the Insane Poor, with special reference to the Insane in Private
Dwellings ........ 472

7. W. Gihaon, 1C.D. Lond. — Clinical Cases illustrative of the value 5f the

Thermometer as a meaiis of Diagnosis in Diseases of the Nervous
System ........ 497

Thomaa Beafh Christie, 1C.D. — A few Observations on the Treatment of a
Certain Class of Destructive Patients, as pursued at the Colney Hatch
Asylum .••••... 508

8. W. D. Williams, K.D.— A few Words in Answer to Dr. Edgar Sheppard . 510

linderic Sateman, K.D., K.B.C.F. — On Aphasia or Loss of Speech in Cere-
bral Disease ........

Occasional Notes of the Quartxb.

The Sanity of Louis Bordier

The Alton Murder . . •

Civilization in Southern Italy

Insane Negroes in the United States

Psychological Intuition • •

The Carmarthen Matron

The Irish District Asylums for the Insane

521

532
548
550
552
553
554
556

PART ll.-REVIEWft.

Editorial Note

563

>■«

ii CantenU,

PART lll.-QUARTERLY REPORT ON THE PROGRESS OF PSYCHOLOGICAL

MEDICINE.

PAGE

French Psyehologieal liierature. By John Sibbald, M.D. Edin. — Annales
Medico-psycbulogiques. — Bucliezon the Nervous System and the Con-
nection between Mind and Body. — Medico-legal Report on the Case of
a Man accused of Theft. By M. Achillb Fovillb. — The Utility of
Family Life in the Treatment of the Insane. By Dr. BaiERRB db
BoisMONT. — Passion, Immorality, and Insanity. By M. TiasOT. —
Paralytic Dementia observed in the Island of Cuba. By M. le Docteur
MuNOZ. — Medico-legal Inquiries relative to Insanity. By M. Dagonbt.
— Medico-legal Report on the Case of Seller. By M. Dagonbt. —
Medico-legal Report on the Case of MuUard. By Dr. Hknry Bonnet.
— Medico-legal Report on the Case of Louis P — . By MM. Bour-
auET and V. Combes. — Medico-legal Report on the Mental Condition
of Jacques Raud. By M. V. Combes .... 563—577

PART IV.-NOTES AND NEWS.

Important Lunacy Prosecutions — Another Charge against Dr. Shaw. — Care
and Treatment of the Insane Poor. — L*£mpereur d'Autriche chez le
Baron Mundy. — Epileptic Kleptomania. — A Memorandum on the
Pay, Position, and Education, of Assistant Medical Officers of Asylums.
By Professor Laycock, M.D. — Letters received by the Honorary
Secretary. — Publications, &c., Received, 1867. — Appointments. —
Obituary. — Errata ...... 578-^92

Notice to Correspondents . . . . • • 593

No, 65 {new series No. 29) will he published on the

1st df April, 1868.

THE JOURNAL OF MENTAL SCIENCE.

[FMUTted hy AMthority of the Medico-FsycJiological Association^]

No. 64. "^^o""^^"' JANUAEY, 1868. * Vol. XIIL

PART l.-ORIQINAL ARTICLES.

Some ObservatioTis on the Phenomena of Life and Mind,
By EoBBRT Dunn, F.R.C.S., &c.

(Head in the department of Anatomy and Physiology ^ at the Meeting of the
British Association, at Dundee, September, 1867.)

LiPB and mind, in their abstract nature or essence alike inscrutable
to us, are problems which belong to the same category ; for, in this
world, we know nothing of life apart from an organism, and we
have no manifestations of mind independently of a brain and nervous
system. Here living organisms are required for the display of the
vital phenomena, and a brain and nervous system for the manifesta-
tions of vmind. Life has accordingly been defined as " the collective
expression for a series of phenomena which take place exclusively
in bodies that are organized,'^ and *' mind as the functional mani-
festations of the living brain.^' But then, and at the outset, it is
to be remembered that in affirming sensation, emotion, thought,
and volition to be functions of the nervous system, what is really
maintained is this, that the vesicular matter of the encephalic ganglia
furnishes the material conditions — the medium through which these
mental phenomena are made manifest in this life. It may indeed
be asked, Are not the physical forces of external nature, which underlie
all vital phenomena, and the changing states of consciousness which
constitute our mental life, as inscrutable to us in their nature or
essence as are life and mind ? and it must be conceded that they are.
Matter and force are coexistent, and are correlative. Nor can we
conceive of the one but in association with, by, and through the
other, any more than we can conceive of life, in our present state of

VOL, xin. 31

438 Some Observations on the Phenomena of [Jan.,

existence, apart from an organism, or of thought independently of a
Uvingbram.

Mr. Grove has indeed most convincingly shown that the correla-
tions of the physical forces, the convertibility of one form of force into
another, points to a unity of force ; nay, more, leads, as he thinks,
to the belief that " the two fundamental conceptions of matter and
motion will he found sufficient to explain physical phenomena '' *
The agency of motion in the manifestations of both life and mind is
unquestionably important, and strikingly conspicuous, so that motion
has been regarded as a kind of common ground upon which nature,
life, and mind may be said to meet. In every living organism there
are ceaseless motion and change, and the dynamical agency of mind
in the production of motion is seen in all our voluntary movements
and volitional acts. Whatever, indeed, may be the notion enter-
tained as to the abstract nature of mind, mobility and sensibility
are its primordial points of contact with the external world or nature.
But still the phenomena of life and mind are so antagonistic to, that
they are not to be identified or confounded with, nor can they be
included under, mere physical phenomena : for, while matter and
the physical forces suffice for the explanation of the physical pheno-
mena of nature, to these require to be superadded a living organs
ism — germinal matter with its vital force, for the display of the
phenomena of life, — and to these, again, the further presence
of a nervous system, and the vesicular matter of the encephalic
ganglia, with their inherent nervous and mental forces, for the mani-
festations of sensibility y intelligence, and thought. The fact, indeed,
cannot be denied, that the agency or co-operation of matter and the
physical forces is as essential to the manifestations of life as life itself
is to the display of the mental phenomena, of which consciousness
is the exponent, so that physical, vital, and mental phenomena have
been considered, and may perhaps be most correctly regarded as
the expression of successive and ascending developments of force,
each sui generis ; for they are not to be confounded, and cannot be
identified with each other.f The spontaneity of the actions of the

* Tide Address of W. R. Grove, Esq., Q.C., MJL., F.R.S., President of the
Meeting of the British Association, at Nottingham, 1866.

t I am aware that the existence of a distinct vital force has been and is ignored
by some distinguished physicists. Grant, say they, a living organism, and then
the agency of the physical forces is all-sufficient for the display of the vital pheno-
mena, heat playing an aU-important part in their production. But, waiving this,
I would here briefly remark, that the correlations of the vital, nervous, and mental
forces present to the psychological inquirer and thoughtful practitioner a subject
fraught with deep interest and importance, seeing that vital power supplies nervous
energy, and the nervous force mental activity. The transformation of these three
forces — the vital into the nervous, and the nervous into the mental, and their con-
verse— ^thus interchanging and interchangeable, with their attendant consequences,
the expenditure of the one supplying new energy and vigour to the other, opens out
an interesting field for observation and inquiry, and clearly points out how impos-
sible is the attempt to isolate mental facts from all those of the nervous and vital

1868.] lAfe and Mind; hy Bobeet Dunn. 439

living organism^ and its vital force, — ^its self-constructing, self-main-
taining, and self-propagating power, — cannot be identified with, for
it is totally distinct and different from, any ordinary physical force —
compelling, as it does, the elements to take up their required special
relations, and thus drawing a broad line of demarcation between the
simplest living organisms and the most perfect mechanism of human
construction.

Again, as Professor Beale has justly remarked :

"Let no one conclude that anything is gained by regarding
nerve force as electricity or some mysterious unknown correlative
of ordinary force, of the nature of which we know nothing. If
we admit it to be ordinary dectricity, the problem is not solved ;
for it is obvious that its manifestations are due entirely to the
peculiar arrangement of the nerve-cells and fibres which constitute
the mechanism for setting free and conducting the currents. It is
not possible to conceive nerve phenomena without a special nervous
apparatus, and it would be absurd to ignore this apparatus in con-
sidering the nature of nervous action. The action of the machine
cannot be dissociated from its construction. But the construction
of the apparatus and its maintenance in a state fit for action are due
to vital power. The lowest, simplest, and least varied kinds of
nervous action, like all other actions known in connection with the
Kving elementary parts of living beings, are intimately connected
with vital changes, and cannot be accounted for by physical and
chemical laws only. When we ascend to the consideration of the
higher and more complex nervous actions, we find reasons for con-
cluding that the vital acts perform a still more important part. In
the brain of man we have probably the only example of a mechanism
possessing within itself not only the means of repair, but the capacity
for improvement and the power of increasing the perfection of its
mechanism, not only up to the time when the body arrives at
maturity, but long after this, and even in advanced life, when many
of the lower tissues have undergone serious deterioration, and have
long passed the period of their highest functional activity.^' *

" Life,^^ t he has well observed in his able exposition of the sub-
ject, founded upon microscopical investigation, " is a state of action
and of change. Within every living organism, and every elementary

Bystem with which they are so closely interwoven. At the same time, while we
note the perpetnally-recumng metamorphosis of nerve-force into mind-force, and
of mindforce into nerve-force, we know it to be a physiological fact that the
vesicular matter of the cerebrum is the material substratum through which i^Xxe
metamorphosis is effected i and, indeed, have wc not actual proof of increased dis-
integration of the nervous tissue in the redundant amount of the alkaline phot^
phates in the urine when the centre of intellectual action has been overta&cd ?

• Vide * How to Work with the Microscope,' 4th edition. Churchill, p. 338.

t Vide * Introduction to the Physiological Anatomy and Physiology of Man,*
by Lionel Beale, M.D. Longmans and Co., 1866.

440 Some Observations o?i the Phenomena of [Jan.,

part or cell, are ceaseless motion and change. The absorption of
new lifeless material, its conversion into living matter, and the
removal of that which has ceased to live, comprise a continuous suc-
cession of actions, in which organization and disorganization y life
and deaihy are unceasing/' He justly adds, " But in these actions
are comprised phenomena of two distinct classes, different in their very
nature — physical phenomena and vital phenomena — ^physical pheno-
mena which occur in the external world, and phenomena truly vital,
the nature of which is not to be so explained, — such are the pro-
cesses of formation, growth, and multiplication, and occur in living
beings only, — whereas the development of heat, light, electricity,
and such like, Sive physical phenomena, whether they occur in living
organisms or in inanimate matter.

The living germinal matter alone is the seat of vital actions, while
in the lifeless formed material physical and chemical phenomena are
in operation." * Now, life in its mysterious association with matter
is transmitted from one living being to another. Every living par-
ticle comes from a pre-existing living particle, for in every instance
matter derives its vital power or properties from a previously exist-
ing organism. The vital part of the impregnated egg consists of
living matter, which results from living matt<er belonging to the
organisms of the beings that produced it. It manifests a life inde-
pendent of its parents, and undergoes development if the requisite
physical conditions are supplied.

But, on the other hand, " every attempt," to use the words of
Dr. Beale, *'to give vitality by means of the physical forces to
inanimate matter has been vain and futile. Not the slightest ap-
proach, by any means, has been made towards the formation of
anything having the properties of the lowest and simplest form of
living matter. All attempts by synthesis at the formation of albu-
men or fibrine, nay, even of starch or the cellulose of the very lowest
vegetable organisms, have been unsuccessful."

"How beautiful," as observed by Todd and Bowman, '^is the
provision which this power> possessed by organized bodies of gene-
rating others, affords for preserving a perpetual succession of living
beings over the globe. The conmiand, *' increase and multiply,^*
has never ceased to be fulfilled from the moment it was uttered.
Every hour, every minute, brings into being countless myriads of
plants and animals, to supply in lavish profusion the havoc which
death is continually making ; and it is impossible to suppose that
the earth can cease to be in this way replenished until the same
Almighty Power that gave the command shall see fit to oppose
some obstacle to its fulfilment." t

Mental Phenomena, — Turning now to the consideration of the

* * Physiological Anatomy of Mau.' f Ibid.

1868.] Life and Mind; by Bobeet DuniT. 441

mental phenomena, of which consciousness is the exponent, — and
here, let me say, I confine my observations to such mental pheno-
mena,— I would, begin by observing that in limine it may literally
be said that from the first moment the primordial cell-germ of a
human organism comes into being, and is launched upon the ocean
of time and space, the entire individual is present, — an organized
entity exists, fitted for a human destiny ; and that from the same
moment, mattery life and mindy body and soul, are never for an
instant separated, their union constituting the essential mode of our
present existence. The mind, like the body, passes through its
phases of development and growth. The germs, so to speak, of all
our activities — sensational, emotional, ideational, and intellectual —
as constituent elements, are present from the first. They exist
implicitly y ah initioy in every mens sana, and they are all in due
order and succession evolved explicitly as the different phases of
consciousness become developed : for in the primordial cell of a
human organism are potentially contained the vital, nervous, and
mental forces. Inherent in it are the powers of nutrition, develop-
ment, and growth, under which, in utero, daily supplied with the
nutrient pabulum, the bodily fabric is evolved and built up in ac-
cordance with all the subsequent wants of the future man. Not
only the osseous, muscular, and vascular systems, but the nervous
apparatus also, upon the vesicular matter of the encephalic ganglia
of w^hich, the mnid is dependent for the manifestation of all its
phenomena throughout the totality of life in health and disease.
As soon, however, as embryonic life is passed, and an independent
existence, an individuality is established, the nascent consciousness
becomes awakened, roused into activity by stimulus from without,
the infant mind responding at birth solely to impressions from
without or to instinctive feelings from within, sensibility and mobility
being its primordial points of contact with the external world. This
nascent consciousness, purely sensational at first, emerges gradually,
step by step, from self-consciousness to world-consciousness, and
through the ideational and emotional, up to its highest phase of
intellectual development. Thus, our outer life begins with con-
sciousness, and, it may be said, with consciousness to end ; for, on
the cessation of consciousness, life, reduced to a series of mere
automatic movements speedily becomes extinct. Consciousness
itself, as the exponent of mindy is an ultimate fact'in animal life,
beyond which we cannot penetrate. It implies mental existence y
and is the universal condition of intelligence, for it is involved in
every sensation which we experience, in every mental act that we
perform, in feeling, perceiving, thinking, and willing. In a word,
it is individuationy and equivalent to the knowledge which we pos-
sess of our own personal identity. It is Uke life, one and indivisible,
for the unity of consciousness is the deepest and most indisputable

442 Some Observations on the Phenomena of [Jan.^

fact of our nature ; and to feel, to perceive, to think, and to will, are
so many acts or states of consciousness ; thus the mind works in a
succession of states. Two thoughts or acts of memory, however
closely related to one another, cannot be presumed to exist at the
same instant in our consciousness, each has its own individuality in
time. Swiftness of succession naturally suggests unity of time and
state, which has no real existence, for the mind cannot maintain two
impressions simultaneously. We can indeed best conceive of con-
sciousness in relation to time as an incalculably rapid succession of
acts or states from the moment of birth, and as passing through a
series of developments. These progressive phases of mental deve-
lopment are dependent for their very existence upon the evolution and
material condition of the vesicular matter of the encephalic ganglia
through which they are manifested; for comparative psychology ^ the
study and strict interpretation " of the living experiments,'' to use
the happy and expressive language of the illustrious Cuvier, '' which
nature has presented to us in an ascending series, in the varying
forms of animal existence, from the lowest up to man,'' not only
establishes the fact that sensation, perception, emotion, and intel-
lectual action are distinct states of consciousness successively deve-
loped, but that these states are manifested through different portions,
or nervous centres of the encephalon, and that the human mind in its
progress to maturity passes through these successive phases of
development. Self-consciousness, as the earUest, and consequently
the lowest, is the primary condition of intelligence, and psychology
has been briefly but aptly defined developed consciousness.

In our mental development there are three distinct phases of con-
sciousness successively evolved, and characterised by different psycho-
logical phenomena: — 1. The sensational; 2. The perceptive, or
ideational and emotional; and, 3. The intellectual. For we feel,
before we can perceive or idealise, and long ere we can either reason
or reflect, we manifest the animal instincts and the social propen-
sities, affections, and feelings. And thus to feel, to perceive, or
idealise, and to think, — ^in other words, sensation, ideation, and
intellection, — are different and distinct acts or states of conscious-
ness. And under these three phases all mental phenomena of
which consciousness is the exponent are comprised, and may be
classified and grouped. And 1st. The phenomena whichjbrmulate the
sensational co7isciousness are, besides the intuitions of the special
senses, sensori-motor, consensual, and instinctive actions and feelings.
And among these, common sensibility or feeling, and the capability
of receiving pleasure and pain from mere tactile impressions are
primordial, the most universal in nature, and the most essential to
human existence. Sensation is the link in the chain of being be-
tween the vital and the mental forces, connecting together the con-
acious and the unconscious processes. As a complex act, it is

1868.] life and Mind ; by Robert Dunn. 443

partly within and partly without the consciousness ; but, as soon as
embryonic life is passed, it traverses the line which separates the

f)hysical and vital from the nervous and mental processes, enters the
ight of consciousness, and thus becomes a fact, psychological as
well as physiological.

Man IS at birth the mere creature of sensation and instinct. All
his actions are automatic, reflex, and consensual ; his intelligence is
purely sensational ; his feelings simply those of pleasure and pain ;
and his impulses to action innate and instinctive. But, though the
lowest in the psychical scale, these sensori-motor, consensud, and
instinctive phenomena are not to be confounded with, for they are
altogether independent of, intelligent and volitional actions.

The sad and melancholy spectacle, indeed, has but too often been
presented to us in instances in adult life, where the functions of the
cerebrum having been arrested and suspended, of man reduced to
his primitive condition of mere sensational and instinctive being.
Now, it is in such cases where the cerebrum is benumbed and para-
lysed, and is no longer capable of receiving and acting upon sensorial
impressions, that the sensory ganglia become so strikingly manifest
as an independent centre of action.*

Now, the nervous apparatus of the sensational consciousness of
man consists, to the exclusion of the cerebrum^ of the spinal axis
and nerves, the medulla oblongata, and the chain of sensory ganglia,
including those of the special senses at its summit. These form a
distinct centre of action independent of, and not to be confounded
with, that of the ideational or intellectual consciousness.

2ndly. The Phenomena of the Perceptive or Ideational and Emo-
tional Consciousness, — In Perception, as the correlative of Sensation,
and indicative of its intellectual phase, ideas are formed — sensory
impressions are idealised^ that is, translated or converted into intel-
lectual phenomena, and become the materials of thought. In this
stage of our mental development, to the sensational the Perceptive
Phenomena are superadded : these are Ideation and Volition, with
their associates Memory and Emotional sensibility. The genesis of
the will and of the memory is in the ideational consciousness ; for
their manifestation is dependent upon the presence of ideas on the
mind. There can indeed be no volitional or determinate action, any

* For a strikingly illustrative instance of this kind, I would refer to a case,
which I published, with a commentary on its psychological bearing, in 1855, in
the ' British Medical Association Journal.' The case was one of suspension of the
mental faculties, of the power of speech, and of the special senses, with the ex-
ception of sight and touch, continuing for many months; and it has been
characterised by Dr. Carpenter, in his * Human Physiology,* as the most valuable
example as yet put upon record in illustrating the nature of a purely sensorial
and instinctive, as distinguished from an intelligent existence, and the gradual
nature of the transition from the one to the other."

444 SoTne Observations on the Phenomena of [Jan.,

more than there can be any exhibition whatever of the power or
faculty of Memory, without the existence and retention of ideas in
the mind, and hence Ideation, Memory, and Volitimi are interwoven
with each other, and are one at the root* When, indeed, the per-
ceptive consciousness is in abeyance, they are one and all suspended.
There is an end " to all the enjoyments of the feast, dl the fragrance
of the flowers; and the whole of the associations which they embody
vanish as with a single and magic stroke." — MorelVs Psychology.

But the perceptive consciousness is not limited in the sphere of
its action to the mere ideation of external existences, their sensible
qualities, and physical attributes. It has a far more extended range;
for, excepting the sensational intuitions, all our immediate or intui-
tive knowledge, of whatever kind, has its origin in perceptive expe-
rience. All the ideational activities appertaining to man as an indi-
vidual, emotional and social, as well as a moral and religious being,
are duly evolved and brought into plav as the perceptive, or emo-
tional consciousness, becomes developed.

As sensation is the link in the chain of being between the con-
scious and the unconscious processes, the vital and the mental forces,
so is ideation intermediate between sensation and intellection, — ^the
lowest and the highest phases of our mental development.

The great hemispherical gangUa — ^the acknowledged seat of all
intellectual action and volitional power, together with the centres of
emotional sensibiUty in the meso-cephale — constitute the nervous
apparatus of the ideational consciousness. For, wherever these
hemispheres exist, and in however rudimentary a state of develop-
ment, there we invariably find unmistakeable evidence of the mani-
festation of the essential phenomena of the perceptive consciousness
— Ideation, Memory, and Volition, as opposed to the mere sensori-
motor, consensual and instinctive actions, the phenomena of the
sensational conscidusness.

These crowning ganglia are manifestly superimposed on the
sensory, emotional, and motor centres within the encephalon, and
in close and direct commissural connection with them, for the purpose
of combining and associating instinctive actions and emotional sen-
sibilities with ideational activities, and for offices and purposes the
noblest and most exalted of which the human mind is capable.

3rdly. Tlie Phenomena of the Intellectual Consciousness, — The sen-
sory intuitions of the sensational consciousness, when transmitted to
the cerebrum, are there idealised, by a second ganghonic action, and
become transformed and converted into intellectual phenomena.
And though to perceive and to think are distinct mental acts,
ideation and intellection are inseparably connected, for the percep-
tive intuitions furnish the materials of thought ; and although with-
out ideas there could be no thinking, still an intuitive reasoning

1868.] lAfe and Mind; hy Robert Dunk. 445

process underlies nearly the whole of our mental operations, — ^for,
no sooner is the perceptive consciousness suflBciently developed, and
the mind able to perceive and to look upon objects which are in
striking contrast with each other, than it intuitively begins to com-
pare them, and every act of comparison involves, in the result, the
agency of the cogitative or reasoning faculties. Now, perception
speaks to us from without^ but intellection from withiuy so that the
two mental processes are reversed. And while on the one hand all
our immediate or intuitive knowledge has its origin in perceptive
experience ; so, on the other hand, all our representative knowledge
is the creation or product of the mind's own intellection and intro-
spection— of imitation, imagination, ratiocination, and reflection;
for these, with memory and volition, are the distinguishing pheno-
mena of the intellectual consciousness. It is through them that
man is raised so immeasurably high in the scale of being, and that
the human mind attains to its culminating phase of development in
the highest reason and the^r^^^^ mil,

Eising above sensation and above perception, man soars into the
region of representative knowledge, grasping, through his intellec-
tual'faculties, his reasoning and reflecting powers, fljfi^^mc^ ideas y and
necessary and universal truths, and finding articulate utterance and
expression for them, through the noble faculty of speech, in lan-
guage.

The great hemispherical, as the crowning ganglia of the encepha-
lon, are, as I have said, superimposed on the sensory, emotional,
and motor ganglia, for offices and purposes the noblest and most
exalted. All physiological psychologists are agreed that they are
the sole and exclusive seat of all intellectual action and voUtional
power — of the understanding and the will. But they obviously
subserve difiTerent kinds of mental action. For, as Mr. Herbert
Spencer has well observed : *^ Localization of function is the law of
all organization whatever, separateness of duty is universally accom-
panied with separateness of structure, and it would be marvellous
were an exception to this to exist in the cerebral hemispheres.

" Let it be granted that the cerebral hemispheres are the seat of
the higher psychical activities ; let it be granted that among these
higher psychical activities there are distinctions of kind which,
though not definite, are yet practically recognisable; and it cannot
be denied, without going in direct opposition to established physio-
logical principles, that these more or less different kinds of psychical
activity must be carried on, in more or less distinct parts of the
cerebral hemispheres. To question this, is not only to ignore the
truths of physiology as a whole, but especially those of the physio-
logy of the nervous system. Now, there is either some arrange-
ment, some organization, in the cerebrum, or there is none. If
there is no organization, the cerebrum is a chaotic mass of fibres.

446 Same ObBcrvations an the PAenamena of [Jan.,

incapable of performing any orderly action. If there be some organi-
zation, it most consist in that same physiological division of labour^
in which all organization consists ; and there can be no division of
labour, physiological or other, of which we have any example, or can
form any conception, but what involves the concentration of special
kinds of activity in special places/'*

Of this cogent reasoning of Mr. Herbert Spencer, Dr. Eichardson,
in his recently published lecture, in the ^ Medical Times and
Gazette,' ''On the Local Independency of Nervous ^Function,*'
presents us with a marked confirmation :

" Than the perfection of the isolation of the nervous centres,"
says Dr. Richardson, appeahng to his experiments on the temporary
local destruction of nervous function by the apphcation of extreme
cold, " no fact is more striking. The brain structure is one of the
most indifferent conductors of caloric with which we can become
acquainted. It can receive the force and hold it, but it conveys it
badly. If the force of the nervous system could pass readily and
immediately from one part to an adjoining part by conduction^ indi-
viduality of function would be impossible. There would be bat one
organ, not, as there is, a series of organs linked together in structure,
but isolated in regard to speciality of function. The indifference of
conduction practically secures individuality of action with continuity
of structure so excellently, that we can fully destroy, by the direct
and limited action of extreme cold, the function of a single centre,
without involving any other. It appears to us as though the brain
were made up of portions of the same matter all united into one
organism, but distinctly mapped out into insular divisions, each
well separated from its neighbour, and having its own duties. It is
like a continent, divided into so many nations, all united by soil and
air and other bases of existence, but yet each exercising a special
function in regard to the continent at large, each having its own lan-
guage, its own genius, its own laws." "The only mode," he says,
''in which I can account for this separation and localization of
power, is by the vascular supply of the nervous system, and by the
bad conducting power of the nerve matter. As each centre is sup-
plied with its own vessels, through which alone it derives its force,
and as each centre possesses the power of retaining force, there is
set up an independence of organism in every part sufficiently perfect,
I think, to secure isolation of function with imity of construction.^'
At all events we have the fact, that each n^rve centre is practically
an independent centre oi force.

But it must be borne in mind that Dr. Richardson, on the local
independency of nervous functions, refers especially to physical faets^
and not to the psychological argtcments, which the illustrious Gall

* Spencer's * Principlei of Psychology/ p. 607, 1855.

1868;] lAfe and Mind; by Egbert Dunn. 447

instituted, in regard to the isolation and development of the organs
of the mvtid. He says truly, " In experiments on the inferior ani-
mals with extreme cold, it is only possible to observe the destruction
of those functions which come under the direct observation of the
senses ; symptoms which are motor in character, and which cannot
be traced back to any voluntary — that is to say, any purely voli-
tional— act of the subject/^ " But at the same time,'^ he remarks,
'* it would be unjust not to allude to the circumstance that, by the
process of analogical reasoning, the argument of Gall is powerfully
strengthened. Por, if each portion of the nervous system which
governs motion is an independent local centre of power, it is a fair
inference that each portion of the nervous system governing the
mental acts is also an independent centre of power, smce it is not
probable there would be two methods for the reception of force in
one series of organic structure — a structure which, whether present-
ing itself as grey or as white matter, possesses the same physical cha-
racteristics in respect to the conduction of force/^ — Medical Times
and Gazette, August 17th, 1867.

Now, that different parts or portions of the great sheet of vesi-
cular matter which crowns the convoluted surface of the cerebral
hemispheres subserve, and are the seat of, different and special
psychical activities, is to my mind a well-established fact. The micro-
scopic investigation of its ultimate structure in the three main divi-
sions— ^the anterior, middle, and posterior lobes of the cerebrum, by
my friends, Professor Beale and Dr. Lockhart Clarke, revealing as it
does to us, distinguishable differences and varying degrees of com*
pleadty, warrants, as I think, the inference of diversity of office.
Moreover, as complexity of function is necessarily connected with
complexity of structure, and as it is in the ultimate structure of the
vesicular matter of the anterior lobes, that the greatest complexity
of nerve-cells, nerve-fibres, and circuits are demonstrable, does it not
necessarily follow, as a legitimate deduction, that the grey matter of
the anterior lobes is the seat of the highest and most complex of our
psychical activities?

In conclusion, let me avow what are my own views and convictions
as to the offices or psychical activities of which the vesicular matter
is the seat in the three main divisions of the cerebrum, its anterior
or frontal y middle or parietal, and posterior or occipital regions, the
boundary lines of which may be considered to be broadly marked
out and defined by the coronal suture before, and the lambdoidal
behind. These convictions have not been hastily formed, and although
they are in general accordance with, they are not founded upon, the
multiplied cranioscopical observations of Gall, Spurzheim, Gombe,
and Carus,*^ but upon the facts of pathology observed by myself, or

* In a pai>er read before the Royal Medical and Chirurgical Society, Jane 25th,
1850, and published in the < Lancet,' October 22nd and November 2nd, of the

448 Some Observations on (he Phenomena of [Jan.,

recorded by others, and upon those of developmental anatomy, com-
parative and human, viz. that the anterior lobes of the brain are the
seat of the intellectual, the middle of the personal or individual, and

same year, " On a Cage of HemipUgia with Cerebral Softening^ in which lost of
Speech was a prominent symptom" I took occasion to observe that " the psycho*
logical phenomena of disease present a wide and an interesting field for observa*
tion and inquiry ; and that it is greatly to be regretted the subject has not more
generally engaged the attention of those distinguished men to whom we are so
much indebted for their valuable researches on the pathology of the bndn." I
rejoice in the belief that there now exists less cause for the expression of such
regret, as cerebral physiology t by the pathologist, is no longer unheeded or neg-
lected. I have great pleasure in referring to the valuable contributions of
Dr. Samuel Wilks, " On the Pathology of Nervous Disease,'' in the last published
part of ' Guy's Hospital Reports,' and to the researches of Dr. Hughlings Jacksou,
Dr. Ogle, Dr. Broadbent, Dr. Richardson, and others. Dr. Wilks says truly, " the
discovery of the connection between particular symptoms and deiOnite nervons
lesions, is of the utmost importance in a clinical sense, and of the extremest in-
terest from a physiological point of view." And, again, "the medical man, whilst
treating the diseases of the brain, has very often at the same time to d€»EiI with
the various operations of the mind, which are intimately associated with it.
Indeed, should he really investigate with fuU interest the various examples of
brain disease which c^me before him, he can scarcely avoid being psychologist as
well as physician ; and I venture to affirm that already, by regarding mental
operations in their physiological and medical aspect, the true explanation has heen
given to many of the obscure phenomena of the mind. Pure metaphysics appear
to be becoming a subject of the past, and it is now seen that those who engage
themselves in the study of psychology are fain to' employ the true inductive
method, and to derive these conclusions from observation and experience in the
same way as in every other branch of positive science. Thus it is that the more
advanced opinions of the later metaphysicians have tended in the same direction
as those of the psychologists, and the psychologists are now compelled to study
mental operations as observed in their fellow-men, and no longer wrap themselves
up in their own self-consciousness, and evolve every conclusion from the inner
self. It would be absurd for the metaphysician to adopt his own method, and
arrive at different results from the anatomist and the physician who are studying
the physiology of the brain in health and disease. The psychologist can no longer
ignore the fact that the brain is the material organ of the mind, and that he must
study its nature and its operations, under the most varied circumstances, before
he can establish a true mental philosophy." (* Guy's Hospital Reports,' 3rd series,
vol. xii, p. 158. Churchill and Sons, 1866.)

In closing this note, I would here reiterate what I have myself elsewhere siud :
" The attempt to trace the connection between structural diseases of particular
portions of the substance of the brain, and deranged, impaired, or obliterated
manifestation of the mind, however it may be beset with almost insuperable dif-
ficulties, is, nevertheless, one of vast interest and great importance ; and, to this
end, I cannot suppress my conviction that it is an incumbent duty upon the
medical practitioner to make himself thoroughly acquainted with the principles
and facts of phrenology, and with the respective sites or localities of the difierent
organs in the cerebral convolutions ; and to let no opportunity slip of bringing
phrenological doctrines to the test of experience ; for, if I am not greatly mis-
taken, it is to post-mortem examinations of the brain, and to pathological investi-
gations, more than to any other source, that we are to look, not for the discovery
of normal functions, but for evidence in support or refutation of the dogmata of
phrenology." {Vide 'Medical Psychology,' p. 62. ChurchiU and Sons, 1863.)
To all who are interested in such inquiries and in cerebral physiology, I cannot
too strongly recommend Dr. Turner's Lecture on the Topography of the Brain.
(' The Convolutions of the Human Cerebrum Topographically Considered,' by
W. Turner, M.B. Loud., F.R.S.E. London, R. Hardwick.)

1868.] The State of Lunacy in 1866. 449

the posterior of the social and affectional activities or attributes of
the human'mind. In other words, my mind rests on the conviction —
as I have ebewhere said, in a former paper, ^' On the Influence of
Civilisation upon the Development of the Brain among the different
Races of Man " which I read at the Birmingham meeting of this
great association in 1865 — that the anterior are the intellectual lobes
of the brain, the seat of the intellectual faculties, the reasoning and
reflecting powers ; the middle lobes are the personal, the seat of the
animal activities, of the individual or personal aflFections or attri-
butes, and of the moral and rehgious intuitions of the mind ; and
that in the posterior lobes are seated the social and aflfectional acti-
vities and propensities, those endearing attributes which are the
charm of our existence here, binding together in the bonds of affec-
tion the ties of friendship, of country, and of race. Moreover, I
recognise, with Gratiolet and Vogt, three stages or planes of deve-
lopment throughout the hemispheres of the brain, and in their
tripartite division into anterior, middle, and posterior lobes : 1. The
inferior, or lowest, the basilar and superciliary ; %. The middle,
or medial frontal ; and 3, the highest, — the coronal, or superior
frontal, the sole and exclusive prerogative of man. Nor do I hesi-
tate to avow my belief that it is on the comparative evolution and
relative size of the difftrent cerebral lobes on these stages or planes
of development that the individual character is mainly dependent,
and that while the middle or personal are the dominating lobes of
the brain, as to the animal, moral, and religious activities of the
man, it is the anterior which indicate the character of his intellectual
bearing, and the posterior that of his social tendencies, propensities,
and affections.

The State of Lunacy in 1866 {Great Britain and Ireland).^

The following tables are compiled from the three official lunacy re-
ports of the kingdom, and give (Table I) the total number of lunatics
and idiots in England and Wales, in Scotland, and in Ireland, on the
Ist January, 1867, with their place of maintenance and (Table II)
their distribution per cent, at the same date.

• 1. 'Lunacy. Copy of the Twenty-first Report of the Commissioners in
Lonacy to the Lord ChanceUor.' (Presented pursaant to Act of Parliament.)
Ordered by the House of Commons to be printed, 14th June, 1867. — 2. ' Ninth
Annual Beport of the General Board of Commissioners in Lunacy for Scotland.'
Presented to both Houses of Parliament by Command of Her Majesty. Edinburgh :
printed for Her Majesty's Stationery Office, by Thomas Constable, 1867. —
3. * Lunatic Asylums — Ireland. The Sixteenth Keport on the District^ Criminal,
and Private Lunatic Asylums in Ireland : with Appendices/ Presented to both
Houses of Parliament by Command of Her Majesty. Dublin: printed by Alexander
Thorn, 87 and 88, Abbey Street> for Her Majesty's Stationery Office, 1867.

■a «

He state qfZumuiy in ]

III ||

i ill

4-11, it ||!

1868.]

Ths State of Lunacy in 1866.

451

Table II. — Showing the Distribution per cent, of Lunatics and
Idiots in England and Wales, in Scotland, and in Ireland, on
the \st January, 1867.

ENGLAND AND
WALES.

SCOTLAND.

nUELAND.

Pauper.

Private.

Pauper.

Private.

Pauper.

Private.

In Public Asylums

680

2-5

24-0

15-5

43-7
62-5

None.
3-8

430
100
18-5
28-6

76-8

22-4

None.

1-8

600

84-0

None.

100
90-0

None.

In Licensed Houses

In Workhouses

In Private Dwellings

Total per cent

100-0

1000

100-0

We proceed to furnisli an analysis of the contents of these three
lunacy ' Blue Books.'

I. England and Wales.

The history of the year 1866 forms the twenty-first report of the
Commissioners in Lunacy.

1. County and Borough Asylums, — ^The report commences with
a statement of the progress made in the extension of the public
asylum system during the year. The number of pauper lunatics
and idiots has increased during the ten years 1857-67 from 28,954
to 42,770. To meet this increase great efforts have been made by
the several county asylums. In the year 1844, when the report of
the Metropolitan Commissioners in Lunacy was published, the
county and borough asylums, including the Northampton Hospital,
which then, as now, received paupers, were 16 in number, and con-
tained a total of 4,336 pauper patients. The asylums are now 49
in number, and contain 24,748 pauper patients.

Notwithstanding this large increase of provision for pauper
lunatics, the pressure for further accommodation in many distncts
is most urgent.

The following table shows the ratio in which provision is made
for the insane poor in the various counties of England and Wales : —

452

'[he State of Lunacy in 1866.

[Jan.,

COtlHTT.*

•;;}

9 \

••••••

Anglesey, tee Denbigh.
Bedford ....
Hertford....
Huntingdon
Berks, see Oxford.
Brecon, eee Monmouth.

Backs

Cambridge .
Cardigan .
Carmarthen
Pembroke .
Carnarvon, see Denbigh.

Chester

Cornwall

Cumberland ...1
Westmoreland . . J
Denbigh ..
Anglesey..
Carnarvon

Flint

Merioneth

Derby

Devon

Dorset

Durham

Essex

Flint, see Denbigh.

Glamorgan

Gloucester

Hereford, see Monmouth.
Hertford, eee Bedford.
Huntingdon, eee Bedford.

Kent

Lancaster

Leicester "I

Rutland j

Lincoln

Merioneth, eee Denbigh.

Middlesex

Monmouth

Hereford

Brecon,

Badnor

Montgomery, eee Salop.

Norfolk

Northampton

Northumberland

Nottingham

Oxford \

Berks J

Pembroke, eee Carmarthen.
Radnor, see Monmouth.
Rutland, see Leicester.

{

Pauper Lunatics

and Idiots,

1st January,

1867.

306
436
122

442
407
147
255
198

891
542
387
120
228
146
196
146
77
675
1,238
494
673
974

476
989

1,477
4,602

645
39

826

5,655

376

389

126

951
589
679
614
491
528

}

Accommodation
in Asylums.

540

328
305

212

494
379

278

368

510

Batioof

Accommodation

to Numbers.

63 to 100.

74
75

350
663
491
360
598

61
54
100
53
61

»»

300
631

63
64

660
2,695

45
59

405

»>

586

4,043

459

532
359
431
379

56
61
63
62

n
it
if
ti

• Two or more counties bracketed denote that there is a joint asylum for those
ooanties.

1868,]

Tlie State of Lmaey in 1866.

453

ooTnrxT.

Salop 1 r

Montgomery ...j \

Somerset

Sontiiampton

Stafford

Suffolk

Surrey*

Sussex

Warwick

Westmoreland, tee Cumberland.

Wilts

Worcester

York, East Riding

„ North Biding

„ West Biding ... -

City of Bristol

City of York

Total

Pauper Lunatica

and Idiots,

1st January,

1867.

559

148
1,026
1,126
1,119

771
2,117

841
1,342

755
745
421
483
2,256
492
61

42,770

}

AceomD^dation
in A^bma.

510

521
610
846
400
918
580
1,076

482
584
145
499
1,231
214
30

26,002

Batio of

Accommodation

to Nnmbers.

72 to 100

51
54
76
52
43
69
80

64
78
34
100
55
43
50

if
»>

it
»»

61 to 100.

The Commissioners relate the steps which were taken during
the year 1866 farther to extend the public asylum system. The
union between the counties of Oxford and Berks^ and the boroughs
of Oxford^ Abingdon^ and Beading^ has been, with the sanction of
the Secretary of State, dissolved, and it has been decided to erect an
asylum for the county of Berks on the banks of the Thames near
the Wallingford Boad Station of the Great Western Bailway. In
the county of Chester the justices have determined to erect an addi-
tional asylum for the north-eastern portion, and an estate of sixty-
five acres, about a mile from Macclesfield, has been purchased. At
the Cornwall asylum the new detached building for fifty-two private
patients is completed, and will very shortly be occupied. The old
wards will then be appropriated for a similar number of pauper
patients. It is to be hoped that the example thus set in Cornwall
of providing public accommodation for private patients may soon be
followed in other counties. This plan would result in a direct profit
to the asylum, and would make our public lunatic asylums really, as
ihey are in Grermany and France, the asylums for all the insane of the
county. Until the claims of the middle class thus to share in the
benefit of the county asylum (to the erection of which they have
been rated) are legally recognised, the much vaunted public asylum
system of England cannot be said to be complete.

* A second asylum tot the connty of Surrey, with 660 beds, has been opened
at Brookwood since the publication of this report.

VOL. xin. 32

454 The State of Lunacy in 1866. [Jan.,

In the county of Durham plans are under**consideration for the

fermanent enlargement of the asylum for 328 patients of both sexes,
n the mean time ftlief to the overcrowding has been gained by a
temporary structure of wood with felt roof, containing seventy male
patients, and which was finished in little more than a month. In
the county of Kent the Secretary of State overruled the wise and
well-grounded objections of the Commissioners to a plan of the
visitors for the enlargement of the present asylum at a cost of
£86,000. It almost appears superfluous to enlarge on the dis-
advantages of an over-bmlt asylum, such as the Kent justices are
about to construct. The large sum they propose to spend on this
scheme would have built a new county asylum, with every modem
appliance, for 600 patients, and the old asylum at Banning Heath
might have been used for the reception of the chronic lunatics of the
county. Dr. Kirkman has lost a golden chance of thus advancing
the treatment of the insane poor in Kent, and has instead, untaught
by the failures at Hanwell and Colney Hatch — tacitly, at least —
sanctioned another such blunder.

At the Lancaster asylum, at Prestwich, a detached hospital for
thirty patients has been built at a cost of £75 a bed. Two new
wings for the reception of sixty-five patients each are being added
to the Northumberland asylum. At Nottingham fifty additional
beds have been provided on the female side. An additional asylum for
the county of Surrey, with 650 beds, has been opened at Eookwood.
At the Sussex asylum 130 additional beds have been provided on
the male side, and two dining halls calculated to contain 350
patients each have been built. The asylum has now accommodation
for 700 patients. Two detached cottages have also been purchased
for the treatment of infectious disease. At Worcester the superin-
tendent's house has been converted into male wards, and a sub-
stantial detached house is being built for his residence at a cost of
£3000. It is satisfactorjr to observe that the Commissioners have
given their sanction to this most desirable reform in asylum arrange-
ments. It is neither fitting nor reasonable to place the wife and
family of the superintendent in the middle of a large asylum exposed
to all the noise and discomfort inherent in such a position. The
Scotch Commissioners began the new district asylums on the plan of
providing the medical superintendent with a comfortable and quiet
home, and it is gratifying to find that the EngUsh Board have given
their tardy adherence to the same principle. A site has been pur-
chased, near SheflBeld, with 150 acres, for a second asylum for the
West Eiding of York, and one near Beverley for the North Kding
has also been secured. The plans for the new asylum for the borough
of Leicester have been approved. The asylum is intended for 282
patients, and the estimated cost of the building is £18,300. The
Norfolk and Ipswich boroughs have bought a site at Hellesdon,

1868.] The State of Lunacy in 1866. 455

about three miles from Norwich. Ipswich declines to join the
tmion^ and has bought a site for an asylum of its own two miles
from the town.

Passing from this record of the yearns progress in the extension
of the public asylum system, we have to notice that the Conmiis-
sioners print in detail, in Appendix E, the entries made in the
visitors' book at their official visits to the public asylums in 1866.
These records present a very pleasing picture of the order and
progress which reign in these asylums. There are only two ex-
ceptions recorded. First there is the official account of the treat-
ment at Colney Hatch of patients of destructive habits. The
following is the Commissioners' comment to the Lord Chancellor
on the treatment at one time pursued there in certain exceptional
cases.

In the report relative to the Cohiey Hatch Asylum allusion is made to a
practice which has existed there of placing certain male patients of destruc-
tive habits in their rooms at night in a perfectly nude state, and without bed
or bedding.

The subject, which had led to a correspondence between this Board and
the Gommittee of Visitors, was brought specially under the notice of the
Ck>urt of Quarter Session by Mr. H. Fownall, the Chairman, in February
last ; and the matter is one of such grave importance that we deem it our
duty to report the whole of the circumstances connected with it.

On the 28th of May, 1866, an anonymous written communication was
addressed to the Board, in which it was alleged that two of the male patients
had been most cruelly treated by being locked up at night in single rooms,
" without bedding of any kind, with only the bare boards and brick walls,
and entirely naked.*'

One of the men was stated to have been so treated for ten successive
nights, and the other to have been similarly confined during many weeks.
It was further alleged that other patients had been confined in the same
manner for longer or shorter periods.

Such a system of treatment being, as we believed, quite unknown in the
asylums of this country — certainly not known within our own experience —
we found it difficult to give credit to the statements of the writer ; but
the allegations were of too grave a nature to be passed over ; and, with
a view of affording the superintendent. Dr. Sheppard, the earliest oppor-
tunity of refuting them, his attendance was requested at a meeting of the
Board.

The letter having been read. Dr. Sheppard not only admitted that the
statements therein contained were substantially true, and that a similar
mode of treatment was adopted as a system in cases (of which he said there
were many) where patients were destructive of clothing and bedding ; but
he defended the practice on the ground that the skins of these patients were
of such an unnaturally high temperature, that they were quite insensible to
cold ; that all covering was painful and irksome to them ; and that if clothing
or bedding were allowed they would at once destroy it, and of their own
choice remain naked. He said that all medical remedies failed in such cases,
and that strong gloves had been tried without success. No entries had been
made in the case book or medical journal when patients were restrained by
means of sueh gloves, nor had any of the instances of seclusion in a nude
•ttte been recoraed.

456 The SiaU of Lunacy in 186d: [Jan.,

These disclosures were of so startling a kind, and the practice thus brought
to our knowledge affected so gravely the character of the asylum, that we
at once addressed a letter to the Committee of Visitors, mating them ac-
quainted with all the facts of the case, suggesting an immediate and full in-
quiry on their part, intimating at the same time that, without seeking in any
way to anticipate the result of the inquiry, we in justice to ourselves deemed
it requisite to state that " in all our experience we had known no class of
insane patients to whom such treatment could properly be applied, or would
admit of any kind of justification."

No new facts were elicited by the investigation instituted by the Com-
mittee of Visitors. In the report which they directed him to maJ^e to them
on the subject, Dr. Sheppard again defended the practice of withholding
clothing ana bedding from destructive patients, stating, however, that not
more than five cases had been so treated, and that the number of instances
in which the system had been resorted to had been greatly exaggerated,
neither of the two patients having been actually deprived of all coverings
for more than four nights.

On this point several of the principal attendants were examined by the
Committee, who, to the best of their recollection, were enabled to confirm
Dr. Sheppard's statements ; but as no records of die cases had been kept, no
very accurate intelligence could be obtained.

In forwarding Dr. Sheppard*s report the Committee of Visitors concluded
their letter as follows :—

" The Committee do not exonerate their Superintendent for the course
he has pursued. They feel that he has committed a grave error in omitting
to report this treatment to them ; at the same time they feel it due to Dr.
Sheppard to express their conviction that, in resorting to this treatment, he
was actuated solely by the desire to do what in his judgment appeared to be
the best and most humane for the patients committed to his care. They
have now given positive directions to Dr. Sheppard calculated to prevent
any cause of complaint in future ; and that no exceptional treatment of any
kind whatever be resorted to without such treatment being submitted to
the Committee."

It is satisfactory to be assured that these occurrences will not be repeated,
and it is needless to say that the opinions expressed in our letter to the
visitors are unchanged. We believe that the treatment complained of is not
only cruel, but totfuly unnecessary in any case ; and that such a system of
dealing with the faulty habits of the insane, instead of meeting them and
subdumg them by medical treatment and constant personal attention, would,
if carriea out, gradually lead to all the old repressive measures which have
now happily been almost entirely abandoned. We refer with regret to com-
munications made to some of the leading medical journals, since the date of
the letter of the Committee, in which their Superintendent vindicates what
had thus been condemned ; but while Dr. Sheppard persists in maintaining
erroneous opinions, we do not infer that be has any intention to repeat the
practices they would justify ; and a personal assurance from tiie Chairman
of the Committee has satisned us that the understanding expressed in their
letter will be strictly adhered to.

Secondly, there is the following record of an unhappy exception
to the general favorable reports on the county asylum for Northuni'
berland.

In the Northumberland County Asylum there were four cases, all of
which terminated fatally. There were circumstances connected with Ae

a868.] TAe State of Lunacy in 1866. 467

last of these cases, as reported to us by the head attendant, which in our
opinion called for investigation. The statement was to the effect that the
Assistant Medical Officer, on being called to visit a male patient late on the
nisht in which he was attacked by cholera, went into the ward, and within
a rew yards of the door of the room where he lay, but would not go in and
see him ; that he left the patient in the charge of the attendant without
proper directions for his treatment ; that he (the attendant) then called on
the Superintendent, who, although informed that the Assistant Medical
Officer had not seen the patient, satisfied himself by requesting the Assist-
ftnt Medical Officer to give a draught of medicme which he ordered;
and that neither of the medical officers saw or examined the patient
until the time of their ordinary visit the following morning, ten hours after-
wards.

The visitors of the asylum investigated this charge, and, as the result of
their inquiry, and after communication with our Board, they called upon the
Assistant Medical Officer to resign at once his office. As regards the
Superintendent, who had latterly been unwell, they thought that justice
would be sufficiently met by placing on record their opinion, which they
communicated to him, that his neglect to give immediate personal attention
to the case was most censurable.

2. Tke Insane Poor in Worhhoiises, — ^The Commissioners visited
352 workhouses during the year 1866, and saw there 7,808 insane
patients. The general picture which they draw of the condition of
the insane poor in workhouses is deserving of quotation as a con-
tribution to the question of how far the workhouses may be em-
ployed as houses of reception for chronic lunatics.

The character of the reports [they write] made and transmitted to the
Poor Law Board has been substantially not different from that of those in
former years. Where the inmates of unsound mind are not so numerous as
to require wards for their accommodation apart from the ordinary inmates,
nor of such habits or tendencies as to render necessary a treatment not com-
monly extended to all, the report is generally favorable. And this remark
applies to a considerable number of the smaller country workhouses, where
the few chronic inmates, employed with the rest in doors or in the garden
and fields, frequently enjoying some indulgences of diet by the consideration
of the medical officer, and havmg none of the infirmities incident to the more
helpless forms of mental disease, are even less sensible than the ordinary
pauper of the structural deficiencies of the house, are not depressed by the
narrowness of the airing-yards or the comfortlessness of the day -rooms, and
on the whole perhaps pass a less complaining life than any other class of the
inmates. On the other hand, there has been also frequent favorable report
from houses under quite different conditions, where, as in many of the larger
towns throughout the kingdom, the inmates of unsound mind collected in
the workhouses have become so very numerous as to require special arrange-
ments for their accommodation ; and, the principle bemg admitted of their
claim to a kind of treatment other than that extended to the ordinary
pauper, though the law admits no such claim, the result of the visitation by
memb^ of this Commission, and of the support given by the Poor Law
Board to suggestions made by us which we nave ourselves no power to
enforce, has been to obtain from the respective boards of guardians more
liberal arrangements, better dietaries, improved airing-courts, in some few
instances careful' medical records, and proper paid attendants. To such

458 TAe State qfLuna^ in 1866. [Jan.,

beneficial results we shall have to remark, indeed, srave exceptions, and
some have lost ground even in the past year ; for wonhouse arrangements
exist always on sufferance, there is no authority to compel their continued
observance, and what is done one year mav be undone the next ; but it is
undoubtedly the case that the condition of patients, as a rule, will on the
whole be found most favorable in the very small and the very large houses.
Between these, unhappily, there exist the great mass of the union houses in
town districts, where the numbers of insane poor detained in them are
neither small enough nor large enough for the respective advantages indi-
cated, and which are seldom, therefore, as a rule, accorded to them ; where
patients requiring asylum treatment are detained without anything of asylum
comforts; where there are cheerless rooms, insufficient and incompetent
attendance, a low diet, no records of the simplest kind, and no provision
whatever of healthful exercise for the mind or the body.

The Commissioners express grave doubts of the working of the
8th section of the Lunacy Acts Amendment Act^ 1862^ which

Erovided for the arrangement of licensed lunatic wards in the work-
ouses, with the view of relieving the county asylums ef the con-
tinued pressure on their space. The difiSculties which beset the prac-
tical operation of this clause render it in their opinion very douotfol
whether it can be relied upon as a means of affording any great
amount of relief to county asylums, or of enabling visitors properly
to provide for their insane without building. The provision in the
8th section, that the arrangements in the workhouse for the recep-
tion and care of the patients sent from an asylum shall be subject
to the approval of the Commissioners in Lunacy and President of
the Poor Law Board, no doubt secures for them an amount of care
which they otherwise had no power of insisting upon^ and so far
patients thus removed to workhouses are likely to be placed under
more favorable circumstances than if sent (as many are) under the
ordinary powers of discharge possessed by the visitors. Still, the
Commissioners do not think that even if the difficulties as to the
working of the clause of the Act above referred to should be removed
by legislation or otherwise, it would be at all desirable to carry out
its provisions on such a scale as would in some counties be neces-
sary to afford any material relief to the county asylums.

They would, moreover, view the permanent extension of these
arrangements as a decidedly retrograde step, so far as the legislative
care and protection of the insane is concerned, and that its general
adoption would not only be a great wrong and injustice to the
patients themselves, but contrary to the provisions of the Lunatic
Asylums Act, 1853, which required additional asylums to be built
in counties and boroughs in which the existing asylums are inade-
quate. They apprehend that the provision of the 8th section of the
Lunacy Acts Amendment Act was only meant to meet temporary
pressure in asylums until permanent additions could be made, and
not intended as a means of providing generally for the chronic
lunacy of the country, or of relieving counties and boroughs from

1868.] The State of Lunacif m 1866. 459

the obligations imposed upon them by the Act to provide in other
wajs for their insane poor.

In contrast with these efforts to relieve the yearly overcrowding
of the county asylums by the transfer of chronic and harmless
lunatics to the workhouse lunatic wards^ the Commissioners are of
opinion that for these classes buildings of a simple style, intermediate
in character between the workhouse and the asylum, and consisting
chiefly of cheerful, spacious, and well-ventilated day rooms and dor-
mitories, might be constructed at a comparatively moderate cost.
Without, also, any diminution in the substantial comfort and well-
being of the patients as respects clothing, diet, or care, they believe
that the cost of maintenance would be less than in the county
asylum, and need be Uttle more than that in the lunatic wards of the
best regulated workhouses. The disincKnation which is naturally
felt by many of the superintendents of asylums to sanction the dis-
charge of chronic cases to workhouses would no doubt be con-
siderably modified if proper receptacles were provided for them,
subject, as they would be in every respect, to the protection of the
existing lunacy laws, and under the direct management and super-
vision of the magistrates.

By this means, also, the Commissioners think that facilities would
be afforded for relieving workhouses of cases which do not admit of
being properly taken care of therein, more especially the idiots and
certain of the epileptics.

3. The Criminal Asylum at Broadmoor. — In answer to the in-
quiries of the Visiting Commissioners as to the principles of selection
of persons for custody and care at Broadmoor, they were informed
that, in future, the admissions would be limited to the following
three classes : —

1. Persons found insane on arraignment, or acquitted on the ground of
insanity, whatever the nature of the offence.

2. Persons hecoming or found to he insane while under committal for
murder, and who have not heen arraigned.

3. Convicts who have become insane afler trial, and while undergoing
sentences of penal servitude in Government prisons.

The Commissioners were further informed that no persons
becoming insane while under sentence of imprisonment will hence-
forward be received from county or borough gaols ; that all such
cases will have to be provided for in pauper asylums; and that
patients sent by order of the Secretary of State to such asylums
will not in future be removed thence to Broadmoor, however
dangerous they may have become.

Such exclusion from the State Asylum, however, as an invariable
rule, of the classes last referred to, the Commissioners justly observe,
would not be consistent with the intention of the Legislature, or

460 The State of Lwiacy in 1866. [Jan.^'

•

with one of the main objects for which a criminal asylnm was bailt,
namely^ to relieve county and borough asylums by removing there-
from offensive and dangerous criminal lunatics^ unfit for association
with ordinary pauper patients by reason of their conduct and pro-
pensities^ and requiring special custody and care.

4. Metropolitan Licensed Pauper Houses. — The Gommissipners
confine their observations in this report to those only in which
pauper as well as private patients are received.

The numbers resident in them respectively at the last visit in
1866 were as follows: — Peckham House^ 317; Hoxton House,
244 ; Bethnal House, 374 ; Grove Hall, 404 ; CamberweU House,
356.

The most favorable notice of these houses is given by the Com-
missioners to CamberweU House. The new wards recently con-
structed there having been completed and furnished in a veiy
comfortable and suitable manner, and the management of the house
having been satisfactory, they have consented, with a view of
meeting the present pressure for asylum accommodation, to extend
the licence for 15 male and 10 female additional patients, on the
condition that there shall be a liberal staff of attendants and nurses
in every part of the building.

Yarious neglects are complained of at Bethnal House, and the
Commissioners observe that they " shall adopt stringent measures to
prevent the recurrence of these irregularities.^

This report concludes with the official notification that among the
changes of the past year are to be recorded the resignation of Mr.
Samuel Gaskell, and the appointment, as his successor, of Mr. John
Davies Cleaton, who for some years had been Medical Superintendent
of the West Hiding Asylum at Wakefield. It was matter of much
regret to the Board that the state of Mr. Gaskell^s health had
become such as in his own opinion to render his resignation neces-
sary. He had dischargedthe duties of a member of the Commission
for upwards of seventeen years ; and had rendered to it, with unsur-
passed ability and zeal, services to which his previous knowledge and
experience in lunacy gave peculiar value. The other vacancy in the
Board, previously occasioned by the death of Mr. Eobert Gordon,
has been filled up by the appointment of the Hon. Dudley F.
Portescue, M.P., as one of the unpaid members of the Commission.

The appendix contains a curious correspondence between Mr.
Baker Brown and the Commissioners relative to the (late) London
Surgical Home. It is needless to slay anew the slain. Suffice it to
sav that Mr. Baker Brown had to receive and leave unanswered the
following letter from the Board : —

1868.] 2Sie Btaie of Imnacy in 18661 461

Office of Commissioners in Lnnacy,

19, Whitehall Place, S.W. ; 9th May, 1867.

Sir, — ^The Commissioners in Lutiacy have received your letter of the 12th
of April, with its inclosure from your solicitor, professing to explain what
they had pointed out to you as a very painful discrepancy, between an
assurance given to them by you in a letter dated in January, 1867, that the
institution called the London Surgical Home was not open for the reception
ef females of unsound mind, and an announcement made by you in a book
published in March, 1866, that females of unsound mind had been Already
received and treated in that institution.

Tour explanation is, that you believed the Commissioners to be neces-
sarily acquainted with the statement in your work, published in March,
1866; and that the inquiry they addressed to you, and which elicited the
contradictory statement in your letter of January, 1867, was simply to
ascertain whether any cases had been received since those mentioned in your
book.

Nevertheless, even while supposing the inquiry to be so limited, you
inform the Commissioners that you took advice with your solicitor before
sending a reply, and that the reply sent, distinctly stating that the institution
was not open for the reception of females of unsound mind, and that in no papers
published by authority had it ever been so asserted, was exactly in accordance, not
with the facts^ but with the advice your solicitor gave you.

The Commissioners ought not, perhaps, in such circumstances, to express
surprise that you should suppose them suso capable, with a full knowledge of
the facts contained in your book, to write to you as if those facts were in no
way known to them. But they must inform you, in the strongest language
they can permit themselves to use, that they would have regarded it as an
unworthy deception to call upon you for a contradiction of a statement made
by a reporter in the * Times ' newspaper, while they were content to leave
uncontradicted a statement to the same effect made by yourself several
mouths before.

Your present communication seems to imply that after the publication of
your book you had resolved that no more females of unsound mind should
be received into the Surgical Home; and hence, you now say, your
reference, when first replying to the Commissioners, only to a single case.
That case, however, the Commissioners must remind you, had previously
become known to them by their personal examination of Dr. Urosvenor,
who, for the last twelve months, had been House Surgeon to the Home ;
and, after referring again to your book, they cannot, on this or any other
point, give more credence to your present letter than it has itself authorised
them to give to the letters written by advice of your solicitor.

Of the six insane women treated by you in the Surgical Home, you
assert in your book that five were cured; and in connection with these
alleged cures you remark : *' Of the permanency of the result I myself
am fully satisfied, and I hope at a future time, by a much larger number of
cases, to confirm others in the same opinion."

From this the Commissioners cannot but infer your intention then to have
been, not to close altogether, but to open more widely to the insane an
institution from which all the protection which the Legislature had given to
that class is necessarily absent ; and, presuming you to have had any doubt
of what in that respect was required, they thii^ that upon such a question
of law, rather than upon the question of whether an inquiry as to a fact
should be answered truly, you would have done well to obtain your
solicitor's advice and guidance. I am, &c.,

(Signed) Charxeb F. Phillips.

I. Baker Brown, Esq.

462

The State of Lwutcy in 1866.

[Jan.,

n, SCOTLAKD.

The Beport of the Commissioners in Lunacy for Scotland is
addressed to the Secretary of State of the Home Department. It
is by far the most carefully compiled of the three official reports^
and contains an amount of statistical information which one looks for
in vain elsewhere. It appears that of insane persons in Scotland, of
for whom the Commissioners have official cognisance^ 1,126 were sup-

Sorted by private funds, and 5,490 by parochial rates. At Ist
anuary, 1865, the corresponding numbers were 1,076 and 5,392.
There were thus, on the year, an increase of 50 in the number of
private patients, and one of 98 in that of paupers.

The report commences with a variety oi statistical tables as
to the relations of mental disease in the several counties of Scot-
land. Our limits unfortunately forbid our entering on these
questions. We quote one table of comparative statistics of great
interest.

Table* shorving the rate of Mortality in Scotch and English Aiyhms
in the five years 1861-1865, on the average number resident:

nEAKA.

BOOTLLKD,

BB^OLAITD.

Male.
Mortality.

Female
Mortality.

Both
Sexes.

Male
MortaUty.

Female
MortaUty.

Both
Sexei.

1861

9-61
10-&8
8-79
8-73
7-66

7-77
8-64
7-13
7-40
6-89

8-62
9-55
8-13
816
7-20

12-49
11-67
1209
12-67
1268

8-45
8-14
7-80
9-31
8*44

10-37

9-81

9-83

10-94

10-45

1862

1863

1864

1865

Avermre .........

905

7-66

8*21

12-82

8*42

10-28

The figures from which these results are deduced show that of
every 1,000 patients who die in Scotch asylums, 512 are males and
488 females ; and that of every 1,000 who die in English asylums,
567 are males and 483 females. In French asylums the average
mortality for the years 1854-1866 was 14*03 per cent. ; and the
deaths of male patients were to those of females as 131 to 100.

These results show that the mortality in Scotch asylums will
compare favorably with that in English and French estabUsh-

• Patients in paroohial asylnms and lunatic wards of poor-hooses are embraced
in the Scotch retornB, but not in the English.

1868.]

TAe State of Lunacy in 1866.

463

ments. The smaller male mortality m Scotland is particalarly
remarkable.

From another table it appears that the maintenance rate in the
Scotch District Asylums is rather above the English, which, con-
sidering the inferior accommodation and lower scale of diet and of
wages in the Scotch asylums, is certainly an argument in favour
of the more economical management of large asylums.

This report further contains an admirable summary of the
statutory firovidons for the care and treatment of lunatics in Scot-
land. It is a clear analysis of the several Scotch Lunacy Acts, and
must prove of material service to all engaged in the care and treat-
ment of the insane in that country.

1. Public and District Asylums, — ^There are in Scotland 14
public and district asylums, which had a total population of 3,527
on the 1st of January, 1867. The distribution of the patients in
these different asylums is shown in the following table : —

ASTLrKS.

Priyate.

Panper.

TotaL

Male.

Female.

Male.

Female.

1. Aberdeen Koval Asvlnm

• • ■

1
98
24
111
9
.••
79

a • •

42
37

• • •

3
52

28 '
114
6
•*•

86 :
...
4
24
24
15

114
62
25

131
55

225
29
88

190
20

125

135

• • •

149
65
35

121
61

247
28
85

170
23

108

161
...
91

386
127

64
402
168
697

72
173
525

43
239
362

61
208

2. ArgyU District Asylum

3. Banff District Asylum

4. Dumfries Koyal Asylum

5. Dundee Roy^ Asylum

6. Edinburcrli Royal Asylum

7. Elsrin District Asylum

8. Fife and Kinross District Asylum ...

9. Glasjrow Royal Asylum

10. Haddington District Asylum

11. Inyemess District Asylum

12. Montrose Royal Asylum

13. Perth Royal Asylum

14. Perth District Asylum

Totals

472

417

1294

1344

3527

The general tenor of the reports on the condition of these
asylums is most satisfactory.

New districts asylums are building, and will shortly open for the
district of Ayr and Stirling, The district of Eoxburgh is negotiating
for a site near Melrose. The district of Renfrew has hitherto done
its best to shirk its obligations to provide public treatment for the
insane poor.

The proportion per cent, of the total number of days of main,
tenimce in the various kinds of establishments and in private

464>

the State qf iMuacy in 186&

{Jan.,

dwellings in the seven years 1859-1865 is shown in the following
table : —

1859.

1860.

1861.

1862.

1863.

1864.

1865.

In Public and District

Asylums

35-4

37-2

38-9

39*2

41-0

41-5

42*6

In Private Asylums

120

12-2

12-3

12*6

12-0

11-1

9*8

In Parochial Asylums and

Lunatic Wards of Poor-

houses

16-3

16-2

160

16-2

15-7

16-9

18-2

In Private Dwellings

36-2

34-2

32-7

31*9

31-2

30-4

^9*3

The most notable features of this table are the steadily-increasing
proportion of patients under treatment in public and district asylums,
and the corresponding steady decrease of that of those in private
dwellings.

2. Parochial Asylums and Lunatic Wards ofWorkhotises, — ^There
were on the 1st of January, 1867, 441 patients in the five parochial
asylums of Glasgow (2), Paisley (2), and Falkirk, and 566 in the
lunatic wards of the workhouses. The general condition of these
patients was good in the parochial asylums, and pretty fair in the
workhouses.

3. Private Asylums. — The private asylums of Scotland are twelve
in number. The following table shows the average number there
resident in 1866, with the mean annual mortality : —

LIOBNBEI) HOUSES.

Average Namber
Resident

Proportions of Deaths

per cent,
on Number Resident.

Male.

I'emale.

Male.

Female.

1. Campie Lane House

19-5
43*0
17-0
29-0
7-0
540
560
280
25-0

• • •

100
14-0

20*5
33-0
80
44-5
100
58-0
890
48-5
28*0
19*5
170
31-5

10-2
11-6

• • •

13-7

• • •

1-8
10-7
10-7
28*0

200
7-1

14-6
3-0
...

17-9

• • •

10-3
7-8
7-6

21-4

• • •

17-6

...

2. Ckirnsrad House.

3. Gilmer House

4. Hallcross House

5. Hawkfield House

6. Longdale House

7. Millholm House

8. Newbiirtrinir House

9. SaughtonHaU

10. Somerside House

11. Tranent House

12. Whitehouse

Total

302-5

407-5

10-2

8-6

1 868.] The State of Lunacy in 1 86^: 46S

In this tabk it shoiild be remarked that Saughton Hall and
Hallcross Hall each lost four patients by cholera in this year
(1866).

4. Single Patients [the insane in private dwellings), — '^ In
Scotland/' observes the English Commissioners in their present
report, ^' the practice of placing the harmless and incurable insane
poor as single patients in private houses has been followed for some
years, and is considered to work well. In the year 1859 as many as
1,877 were thus boarded out; since which period the numbers have
gradually diminished, and in the year 1866 they had fallen down to
1,568, while those in asylums had increased in number. These
patients are visited annually (or in special cases more frequently) by
the two deputy inspectors ; and since this has been the practice their
condition appears to have considerably improved. The application
of this system, as a means of relieving the asylums in England and
Wales of their harmless chronic patients, and thus providing for the
reception of recent and curable cases, has been strongly advocated
in some quarters ; the fact, however, being apparently overlooked,
that there are here already upwards of 6,600 of pauper insane so
residing either with their fnends or with strangers as smgle patients.
The amount of out-door relief given to these patients vanes con-'
siderably, according to the circumstances of individual cases, but is
often too low to ensure for them the care and amount of food they
require.

" Under the 66th section of the Lunatic Asylums Act, 1853,
single pauper patients are required to be visited once a quarter by
the medical officer of the parish or union, who is to prepare a list
containing the name, sex, and age of the patient, and the form and
duration of the mental disorder; stating also if the patient is
idiotic, whether so from birth or not, where and with whom
resident, the date of his visit, in what condition the patient was
found, and whether ever restrained, and, if so, why, by what means,
and how often. The medical officer has also to declare whether the
patients are properly taken care of, and may properly remain out of
an asylum. These returns are carefully examined in this office, and
steps are promptly taken to inquire into any cases of an unsatis-
factory character ; and if there is reason to suppose that they are
unfit to be under single care, or are neglected or improperly treated,
steps are at once taken to have them removed to asylums. We have
strong reasons for doubting whether the system could advantageously
be extended so as to afford any material relief to the county asyhm^
or that it works so satisfactorily in this country as to render its more
general adoption at all desirahle.''

The Scotch Commissioners print, in Appendix Y, reports by Drs.
Mitchell and Paterson of their visitations of single patients in

466 7%e State cf Lunacy in 1866. [Jan.,

private dwellings. This daty was performed in 1866 by one of
the Commissioners as well as by the two Deputy-Commissioners.
Dr. Browne visited most of the counties south of Edinburgh.
"Why are his reports to the Board not published in Appendix F,
together with those of Drs. Mitchell and Paterson, in farther
illustration of the real condition of these single patients? There
is a couleur de rase tint spread over the pictures annually drawn
by Dr. Mitchell, and Dr. Paterson rather follows in the steps of his
colleague.

The following extract from Dr. Mitchell's report is an illustration
of the remark just made as to glowing tints in which he paints the
condition of the patients visited by him : —

Some of the patients transferred from asjloms to private dweUings hare
shown a high appreciation of the fireedom accorded to them. One woman,
for instance, who is in a house with a special licence, happens to belong to the
English Church, and she has travellea alone to the chapel^ which is between
two and three miles from her residence, nearly every Sunday for the last
three years. She takes an interest in the affairs of the congregation, and is
well known to the clergyman and to many of those who wordiip with her.
Her relatives often visit her; one of them remained several days, and,
during that time, shared the patient's bed. These visits she is allowed
to return. She is an industrious worker, and, being an excellent needle-
woman, is profitably employed. She stiU believes that she has personal
interviews with the Apostle Paul, and she has other delusions of a like
nature ; but she is very inoffensive and manageable, and requires no more
costly or complicated provision for her comfort and safety than that which
has been made in the clean, tidy cottage of a respectable woman, who
devotes her whole time to the two patients committed to her care.

I could easily multiply pleasing pictures of this kind, for there sire many
parallel cases. It would be a mistake, however, to conclude that such
pictures were anything but exceptional, for the great majority of all pauper
patients in private dwellings, whether they be or be not transferences from
asylums, consist of the fatuous and the idiotic ; that is, of mindless persons
whose appreciation of liberty cannot be so great or so strikingly shown.
Patients in this condition, I tiiink, should always constitute the majority of
single patients. They have been found in practice to be the most suitable.
If freedom, a kindly guardianship, a good bed, and a sufficiency of plain food
and clothing are secured to them, there is little if anything more to be desired.
They will find more to interest them in the every-day occupations of cottage
life than they could in any large establishment. What goes on there, and
what they see there, come more easily within their comprehension and
interest, and they have a pleasure in feeling that they have some little share
in it all, and that personauty is not lost. Their occupations and amusements
may be more commonplace than in asylums ; bat they are not necessarily
the less useful on that account. The cottage kitchen is an ever-shifting busy
scene, and it would not be easy to imagine a tranquil pauper patient,,
passing from acute disease into incurable imbecility, more favorably situated
than at its fireside, where the surroundings are natural and the influences
healthy. I think I am justified in saying that, for such a case, it would be
difficult for the day-room of any asylum to furnish conditions so favorable,
or more likely to arrest the further destruction of the mind. Such a reflec-
tion as this has often occurred to me during my visits to the insane = in

1868.]

7%^ State ofLimacg m 1866.

467

private dwellings, and I have often been led to it bj hearing the parochial
medical man remark that he thonght there was a lest manifest stupidity
about the patients than he had at first observed.

The distribution and results of this visitation of single patients in
Scotland is given in the following table : —

Dr. MitcheU.

Dr. Faterson.

Dr. Browne.

Nnmber of Pauper Patients Visited

„ Private „

„ Patients Unyisited

Recommendations made : —

Of removal to Asylums or Poorhouses
Of change of Guardians or Besidence
Of assistance in Guardianship

647

17
21

2
65
19

18
46

346

647
7
5

11
12
6
158
28
11

50
88

333

352

105

Of supplies of Bed or Body Clothing..,
Of increased Alimentary Allowance ...
Of greater attention to Cleanliness ...
Of more attention to keeping of Me-
dical Resristers

Of a miscellaneous nature

No recommendations considered neces-
Bary

142

■""J • "

The above table contains much interesting matter. Dr. Mitchell's
district seems to require fewer recommendations for improvement
than either of the others. It strikes one as curious to see the small
number to whom suggestions of greater attention to cleanliness
were required. Our knowledge of the interior of the cottages of
the Scotch peasant would have led us to a very different result.
English and Scotch standards of cleanliness perhaps differ more
than we had remembered.

One remarkable fact certainly comes out from these Scotch
reports, viz., the low rate of mortality found under this system ;
probably the lowest rate of mortality on record among the insane
poor. The mortaUty among pauper lunatics in private dwellings in
1865 was as foUows : —

Average Number of
Fatieutf in 1865.

Deaths.

Mortality per Cent.

Male.

Female.

Total.

Male.

1
Female.

Total.

Male.

Female.

Total.

696-0

892-6

1588-5

4*3

5-3

The average cost of maintenance of these patients has risen from
hi» to. 6i^. a day. Dr. Mitchell tells us.

468 The State of Lunacy in 1866. {Jan.,

in. Iebland.

f The sixteenth report of the Irish inspectors is addressed to the
Lord-Lieutenant. The inspectors congratulate themselves that no
case of cholera occurred in any of the public asylums in Ireland^ at
a time when a serious invasion of the disease appeared in the
country^ and affected the general health of the popukition at large.
They addressed the following circular to the superintendents of the
several asylums on the first outbreak of the disease : —

Circular relative to Precauiionary Measures against Cholera,

Office of Lunatic Asylums, Dublin Castle;
4th August, 1866.

SiA, — I am directed by the Inspectors to inform you tbat it is their desire
that in all public lunatic asylums every precaution shall be taken to guard
against cholera, of which serious apprehensions are now entertained, so that
in case it should break out in the asylum under your charge, you may be
enabled to meet it as promptly and effectually as possible.

You will, therefore, be most attentive to an symptoms indicative of
diarrh<ea among the patients, and consult thereon with the Visiting
Physicians.

With reference to dietary and clothinff generally, the Inspectors think that
you and your colleague should consmt for the purpose of making such
alterations as you may deem most advisable, and communicate with the
Inspectors thereon.

They are further desirous that once in each week, viz., on every Monday,
you send up a report to this office of the sanitary state of the asylum.

With reference to isolating patients who may be affected witn cholera —
when no regular infirmary exists — rou will prepare an airy and suitable
apartment expressly for their reception.

I am. Sir, your obedient servant,

(Signed) W. J. Cobbbt, Chief Clerk.

To the Besident Medical Superintendents of
District Lunatic Asylums.

1. The District Lunatic Asylums, — The inspectors proceed to
present an interesting statement relative to the condition of each of
the district asylums now open in Ireland. These asylums are
nineteen in number^ viz., Armagh, Ballinasloe, Belfast, Carlow,
Castlebar, Clonmel (Parent Asylum and Additional Asylum), Cork,
Kilkenny, Killamey, Letterkenny, Limerick, Londonderry, Mary-
borough, Mullingar, Omagh, Sichmond, Sligo, and Waterford. They
furnish in all 5,397 beds.

The inspectors in table 24 furnish a detailed statement of the
names and salaries of the principal officers of these district asylums.
Each of them continues to bear the ornamental burthen of a visiting
physician, at a cost of £100 a year each. Yet nothing can be
more detrimental to the efficient discharge by the resident medical

1868.] The State of Lunacy in 1866. 469

superintendent of his onerous duties than the visits of physicians
with position and authority, which necessarily must clash with and
hurt his own, and this in a position where imperial despotism can
alone ensure success. The of&ce of assistant medical officer is
unknown in the Irish asylums, and a grievous loss to the patient's
and superintendent this want must prove. An apothecary at £50 a
year, without any allowances —a mere dispenser, therefore — ^is sup-
posed to replace this officer on the asylum staflF, The asylum
matron — a species dying out in England — flourishes side by side
in Ireland with the visiting physician ; their average salaries exceed
£100, with allowances, which for Ireland is a high salary.

The unhappy religious divisions of the country require the
appointment of two chaplains to each district asylum^ a Boman
Catholic and a Protestant, except at Letterkenny and Waterford,
where there is only a Roman Catholic chaplain. Armagh and Bel-
fEust do not appear to have either. On this subject the inspectors
observe in their report : —

We find it difficult to reconcile to ourselves how gentlemen of the high
social position and education possessed by the Belfast Board can be so per-
sistent in their opposition to the appointment of ministers of religion
to attend to the members of their own nocks, while deprived by the confine-
ment consequent on their mental maladies from giving voluntary attend-
ance to their religious duties, and more especially to public worship, which
is so marked and so commendable a characteristic of the people of this
country, to whatever sect they may belong.

We again recur to this subject, not from any spirit of opposition to
the wishes of the Board, but because the weight of evidence goes to prove
the inunense advantages resulting to the insane from religious services
and congregational- worship in other asylums. We could quote opinions
without number from the very highest authorities to that efiect — else to what
use have places of worship been provided in all the asylums of the present
day. The position of the majority of the Belfast Board is therefore
perfectly untenable, and, we say it with great respect, places them in
the predicament of maintaining that while they are right in their views the
rest of the world are altogether wron^.

We trust, however, that public opmion will remedy what is felt to be an
intolerable hardship, particiuarly by those who believe it is a religious obli-
gation to assist at Divine service on Sundays, and that a clause will be inserted
in the next Act of Parliament on the subject.

The average weekly maintenance cost in the Irish asylums is 9*.,
which appears high when contrasted with the superior accommodation,
diet, and treatment afforded in the English county asylums for the
same charge.

The tables furnished in this report present a good deal of informa-
tion relative to the history of the district asylums in 1866, but they
are ill-arranged, and present important omissions. Thus, the
absence of all information as to the mean population resident
prevents our calculating the mean annual mortality. Again, there

VOL. xiii. 83

470 jHie State of Lunacy in 1866. [Jan.,

is a carelessness in compilation^ as in table 23. A little more
trouble on the part of the office clerks would there have given us
information as to the relative proportion of single beds and dor-
mitories in the district asylums. At present the figures are only
massed together. Other of the tables might reacGly be a Utile
clearer in form.

2. Tie Insane Poor in Workhouses and Gaols. — The inspectors
remark that they have had no special cause of complaint as regards
the care and treatment of the insane inmates of the poorhooses visited
by us during the year, with a few exceptions.

The total number of cases of mentel infirmity in workhouses on
the 31st December, 1866, was 2,748, as against 2,733 at the end of
the previous year. Of these 866 are simple lunatics, and in 224
cases epilepsy is combined with lunacy, givmg a total of 1,110, of
whom 719, or nearly two thirds, were females. The idiot classes
number 1,638 — 696 males, and 942 females — and of these 1,145
are simple idiots, and 493 are subject to epilepsy as well.

With regard to the insane m gaols, the inspectors further
observe : —

The general subject has been so frequently 4welt upon in our reports,
that it would be mere repetition to enter further upon it here. We maj,
however, observe, as the result of previous representations, that already 19
out of the 39 prisons in Ireland have been returned as without a lunatic
prisoner at the end of the year ; 5 contained 1 each only, 4 had from 2 to 5,
the remaining 1 1 gaols havmg an average of 29 insane inmates.

The reduction in the number confined in gaols, which we have now
the satisfaction of reporting, is principally owing to the accommodation sup-
plied by the new asylums at Letterkenny and CasUebar, the opening of
which enabled us at once to relieve the gaols of both those districts of all
their insane inmates.

In fact, one of the objects to which we have mainly devoted our attention
for many jears, is the removal of lunatics from prisons; and we look
forward with unqualified satisfaction to the arrival of the time, now not
distant, when the further accommodation at present being provided at Enois,
Downpatrick, Monaghan, and Enniscorthy, by the erection of district
asylums at those towns, together with some other extensions under con-
siaeration, will effect a general clearance of the lunatic Inn^ates, leaving the
prisons free to be devoted to their own special use?, no longer incommoded
by the disturbing element of insanity, for the treatment of which no suitable
provision exists in them, and whicn therefore embarrasses the officials, and
unavoidably interferes with the regular discipline of those places.

Moreover, institutions of a punitive character must in general exercise an
injurious influence upon the mentally affected ; though at the same time we
are bound to record the fact that very many persons are discharged from
them cured of insanity, from the restraint put upon their freedom of action,
coupled with the judicious medical treatment which, under such advan-
tageous circumstances, they receive while in custody.

3. Central Asylum for Criminal Lunatics. — ^The numbers in this
asylum on the 31st December, 1866, were 87 male, 45 female, total

1868.] The State of Lunacy in 1866. 471

132. The working of this institution, say the inspectors, to which,
being placed under our inunediate, or we might say our exclusive,
control, our attention is given in a special manner, continues to be
highly satisfactory. Standing in the position occupied by Boards of
Governors with respect to district asylums, the functions exercised
by us in regard to its affairs are in every way similar, the estimates
being framed, contracts for suppUes obtained, and the accounts
vouched monthly by us, in addition to our inspectorial duties.

4. Private Asiflums. — ^There are 293 male and 320 female, total
613, patients in the twenty private hcensed houses in Ireland. The
inspectors exercise great vigilance in the supervision of these
asylums. Th^ view the whole system, however, with marked
disfavour. '' In our last report we referred in general terms to im-
perfections to be found in these institutions, observing that ' such
faidts are indigenous, and clearly traceable to inherent defects in the
system, so that all we can do under such circumstances is to con-
tinue our efforts to ameliorate by constant supervision the condition
of lunatics in private asylums.^ These remarks are still applicable,
and will continue to be so while the present system exists.^'

Of patients boarded in '^ private dwellings,^^ the inspectors appear
to have Uttle or no information whatever. Of unlicensed houses
they record the following : —

In one instance a medical gentleman of respectability had t«7o persons
residing with him whose mental condition was such as to necessitate their
being placed under medical treatment, and at the same time under certain
restrictions as regards their freedom of action. The case was submitted for
the opinion of the law officers, who decided that the house should be
licensed, and Dr. Bewley, the proprietor, has accordingly sought for a
licence, which will be issued to him at the next quarter sessions.

In another instance we ascertained that a farmer residing in the county
Wicklow, had several insane persons in his house under the name of lodgers,
and on inspection we found such to be the case, three persons, 1 male and 2
females, being located therein. He seemed quite unaware of the requirements
of the law, and as the parties appeared to be well cared for and comfortable^
we did not think it necessary under the circumstances to call for a prosecu-
tion for breach of the Act. One of the femaU^^ a young unmarried woman, was
discovered to be wegnant, but on investigating the circumstances we could
find no clue to ner seducer. We of course caused the removal of all
three immediately, and regret to add that the female in question, who was
taken away by her friends, died, as we were informed on inquiry, during
parturition.

The inspectors look for the remedy of these evils through the
provision of middle-class asylums. " It is,^^ they say, " a matter of
the utmost difficulty to obtain information relative to persons of the
class above referred to, who are either residing with their relatives,
or living as lodgers in the houses of strangers, and who would pro-
bably be placed in private licensed houses but for the inability or

472 The Care and Treatment of the Imane Poor ; [Jan.^

unwillingness of their friends to incur the expense. We have no
doubt that if intermediate asylums existed in which they could
be maintained at a reasonable rate^ very many lunatics above the
rank to which the inmates of district asylums ordinarily belongs
would find their way into theip."

C. li. fi.

The Care and Treatment of the Insane Poor, with special reference
to the Insane in Private Dwellings. By Aktuur Mitchell,
M.A. and M.D. Abdn., F.K.S.E.» &c.^ Deputy Commissioner in
Lunacy for Scotland.

In his address as President of the Medico-Psychological Associa-
tion Dr. Bobertson discusses the various modes of making public
provision for the insane poor \ and one of the three modes which he
recommends is that of disposing of a certain number of them in
private dwellings.

In examining the merits of this system, the experience and practice
of Scotland receive much attention, one half of all, he says on the
subject, having reference to what has been done or written in that
country. He is also good enough to attach considerable value to an
official statement of mine, which bears on the question, and part of
which he quotes. It appears to me, however, that Dr. Eobertson^s
statements and remarks do not exhibit the true aspect of the case
in Scotland, and are calculated to mislead; and I am, consequently,
induced to offer some comments on them, derived from the oppor-
tunities of observation which I have possessed.

The address recognises the principle that the insane poor are not
to be provided for in one inflexible way. Provision is to be made
for them according to their requirements, and it is admitted that these
vary. The management of insanity is not to depend on its name,
but is to be determined by the varying needs of those labouring
under it. AsyhimSy poorhmses, and private dwellings are accord-
ingly sanctioned and recommended; and among them Dr. Robert-
son says that the whole of the insane poor may be distributed '' with
due consideration of all their claims and requirements.^'

Common sense recommends the principle which underlies these
views as a sound one, and this deliverance of that excellent judge
is confirmed by all we know both of mental disease and of diseases
generally.

1868.] ^ De. Arthur Mitchell. 473

Without formal acknowledgment^ perhaps^ but still in fact, the
principle is a guide of action with all physicians engaged in the
treatment of insanity. One patient, regarding whom advice has
been asked, is removed at once to an asylum, another is sent to
travel, another is taken from home and boarded with strangers,
another is left among his friends, and so on — the counsel given to
diflPerent patients being regulated by differences in their condition
and circumstances. The very statutory certificate on which a lunatic
is placed in an asylum recognises the same principle, since it is neces-
sary that it shall not only certify the person to be of unsound mind,
but also that he or she is a fit and proper object for care and treat-
ment in an asylum. Our whole laws, indeed, (for England and
Scotland both, though not equally) rest on the idea that some of the
insane may properly be left out of asylums, and they accordingly
make provision, more or less effective, for the protection of such
patients.

If Dr. Eobertsotfs scheme for the care and treatment of the
insane poor risea from a foundation so widely approved of and so
secure, wliat room is there for any comment but such as is favor-
able, and what need is there of that ? None, I reply, were it not
that the address has another distinguishing feature. It blows both
hot and cold ; says yea and nay almost in the same breath ; gives
with one hand and takes away with the other ; approves and con-
demns without apology or explanation — thus involving the author
in puzzling inconsistencies, and leaving the reader nowhere.

Baron Mundy declares the address to be ^' a protest against in-
discriminate sequestration^^ of the insane, and there is a great deal in
it to justify that strong view of its character. Yet, if he had
called it a plea for ^ instead of a protect against^ I am not sure that
he would not better have designated the first impressions of most
readers. Last impressions, of course, will derive their character
from the fact that the residence of a certain and considerable number
of the insane poor in private dwellings is sanctioned and recom-
mended.

The views which Dr. Robertson expresses will be gathered, I
think, from what follows.

He makes frequent allusion to ^' harmless and incurable lunatics ^^
and to the '^ chronic and harmless stages^' of mental disease, and
points out clearly that asylums are only needed for the ^' majority'^
of the insane.

One fourth of their whole number, indeed, he says, may be
provided for in poorhouses,* " with due consideration of all their

* Foorhofue wiU be used in this communication instead of utorkhouse* There
is something unpleasant in speaking of providing for the insane in a workhaute.

474 1%€ Care and Treatment of tie Insane Poor; [Jkn.,

claims and requirements/^ and ^^ with satisfaction to themselyes and
their friends.

He then further disposes of 15 per cent, of their number in private
dwellings. " I am very far from asserting the opinion/' he says,
*' that all the insane poor without exception ought to oe treated in the
county asylum or in the workhouse. A certain proportion might, witk
increased enjoyment of life^ be restored to their own families /' and
he elsewhere tells us that there are patients now in a^lnms who
" might certainly, under proper restrictions, be restored'' to their
homes.

Something of the nature of the '' increased enjoyment of l^f^^ to
which he here refers, we learn from a statement he elsewhere makes
to the effect that, with a certain class of patients^ '' mixing with per-
sons of sound mind is a comfort much appreciated, as also the
greater freedom, the facility of visiting old mends and associations,
and such like/'

But it would not simply be a certain number of the insane who
would derive happiness from the operation of Dr. Robertson's kindly
views, for he feelingly tells us that '^ great comfort would result
to many families in having their afflicted] loved ones again with
them." Both the patients and the friends of the patients would
thus be benefited ; and this is not yet all, for the advantage would
extend to the asylums themselves. By adopting this home
treatment. Dr. Kobertson says that '' the confidence of the poor
in the authorities of the asylum would be greatly strengthened,^^
This important statement may be appropriately linked to another
from the same pen, which tells us that asylum populations '' in-
clude a large proportion of incurable lunatics, whose treatment,
speaking generally, is a matter of organized system rather than of
individual observation" This opinion differs considerably from what
we sometimes hear about the soothing, healing, and elevating in-
fluences which flow to every patient, in every asylum, from constant
personal intercourse with the physician at the h^d of it, who, how-
ever great his kindliness, and zeal, and skill may be, is thus credited
with performances which are impossible, and which Dr. Robertson
says are not real. The days of no man are fuller of good deeds than
are those of an asylum physician, and the discharge of no duties in-
volves a greater abnegation of self than does the discharge of his^
but when we read '^ of the forbearance, the outpourings of kind-
ness, and attention and adroitness, if not the delicacy, required
and positively exercised towards the insane by their guardians,
even in the worst asylums," "^ and when we remember that these
words have particular reference to patients in the chronic stages of

* The italics are not Dr. Robertson's.

t Journal of Mental Science, vol. xi, p. 279.

1868.] by Dk. Abthur Mitchbll. 475

mental disease, and are intended to cover asylums of all classes, we
should instinctively feel, if we did not actually know or had never
been so told, that this is an overshooting of the mark. An ad-
mission like that made by Dr. Robertson more correctly states the
fact, nor is its doing so inconsistent with the highest possible praise
of the medical management of our asylums.

I am half inclined to think that Dr. Eobertson will be surprised
to find that he has uttered all these good and sensible things. I
count, indeed, upon his gratitude for having reproduced them, and
hope I have succeeded in showing that, in recommending a certain
number of the insane poor to be disposed of in private dwelings,
he has been guided by views which are sound. He finds, for
instance, in asylums a number of patients whose removal to private
dwellings would, in his opinion, be attended ^^ with increased enjoy-
ment of Hfe /' and of course he does all that in him lies to effect
their removal. He believes, further, that in doing this he will confer
a pleasure on the friends of the patients, and will, at the same
time, effect the desirable end of strengthening the confidence of the
poor in the authorities of the asylum. To better the lot of the
patient, to give a proper pleasure to his friends, and to cultivate
the confidence of the poor — in the hope of accomplishing such
things as these, he recommends the return of the patienft to his
home j and he does it all the more readily, perhaps, that the treat-
ment of the patient, if he remain in the asylum, will be ^^ a matter
of organized system rather than of individual observation.^^

At various times and from various quarters opinions of a charac-
ter not unlike the foregoing have been expressed in Scotland.
Attention to the subject was first awakened by the appearance
of a series of articles in the ^ Scotsman^ newspaper. Since that
time the annual reports of the Commissioners in Lunacy have
contained many clear expressions of their views on this important
subject. By these views entirely has the Scotch practice been
regulated, and everything I have myself written I believe to be
in substantial accord with them. Tliat a certain number of the
insane poor, carefully selected and under proper restrictions, may be
satisfactorily provided for in private dwellings, is the opinion held
and acted on by the Scotch Board, and it will be found to rest on
considerations very much like those which have pushed Dr. Robert-
son to the same conclusion. Yet, with a curious inconsistency
everything that has been done and said on this matter by the
Scotch Board receives from him a wholesale condemnation, delivered
in an off-hand and summary, but excathedral style. Some reasons
for this condemnation are of course assigned ; but I think it will be
easy to show that they are either founded on misapprehension or
may be resolved into a way of putting things, which prejudice tempts

476 Tie Care and Treatment of the Insane Poor ; [Jan.^

the best of men occasionally to adopts giving no immunity e?en to
presidents.

It seems to me that I shall be best able to show this by taking
up point after point, without an embarrassing r^ard to connected-
ness in their order. And if, in the course of what I am led to
say, T succeed in disclosing the scope and nature of what has been
called the Scotch system more fully than has yet been done, I
hope that I shall have accomplished a task of some usefulness.

I. In my last general report to the Commissioners I stated, as
the result of experience, that the nuyarUy of single patients should
always consist of ''the fatuous and idiotic,'' and Dr. fiobertson says
that the very '' existence of the system is condemned by this official
admission.^'

With reference to this, on the threshold, I think all will agree
that my personal opinions on this subject may be either right or
wrong, without aff^ng the existence of a system over which no
man can have any such summary power of life and death.

The paragraph from which Dr. Bobertson quotes follows the nar-
rative of a case of delusional insanty, in which the ''increased
enjoyment of life,^' after removal from the asylum, had been very
apparent and very strongly expressed ; and it was written to point
out that such cases were exceptional, and to prevent misunder-
standing.

I adhere to every word of my statement, which embodies an
opinion the result of actual observation, but which has no such
peculiar weight as that now given to it ; and I b^ to point to the
tlighth Beport of the Scotch Board for a foller expression of my
views on the subject.*

But, before leaving the point, let us see what there is in the
statement which is so fatal. It certainly is a fact that a considerable

****** The fbrms of difleaae which, in my experience, have been found to
be most suitable for care in private dwellings are idiocj, imbecility, and dementia;
and of the existing single patients more tlum 80 per cent, laboor nnder these forms
of insanity — 60 or 70 per cent, being idiotic or imbecile. The class sometimes
spoken of as the " semi-insane" do not as a rule prove easily managed in private
dwellings, nor do those patients labouring under ** delusional insanity,*' especiaUy
if the delusions be those of suspicion. In the class of cases which I have found to
be most suitable, the unsoundness of mind is weU marked, but in the direction of
weakness or destruction rather than of perversion of the mental fiumlties. Their
mental state should be one of delect rather than of disease, and should be a
settled and well-established condition, and not a prc^^ressive or changing (me.
So far as mind goes, their condition should as much as possible be one simply of
lotMf or want, or voids and such patients are to be found among idiots, imbeciles,
and dements, that is, among the fatuous; for idiocy and imbeolity may properly
be regarded as the fatuity of infancy or youth.

** What I have said neither supposes that all the fatuous can be properly man-

1868.] hy Dk. Arthur Mitchell. 477

majority of the insane in private dwellings in Scotland may be
tabulated under the headings of the demented and idiotic; but
is not the same thing true also of the 6^638 single patients in
England ; is it not true^ also, of the 13^ single patients in
Sussex; is it not true^ also, of the inmates of poorhouses, and
is not the truth of all this known to Dr. Eobertson ? With
reference to the 6,638 single patients in England, does he not say —
^^ They are chiefly cases of idiocy and dementia ?^' With reference
to the single patients in his own county, does he not say — '' They are
chiefly idiots ?^'^ With reference to the lunatic inmates of the
ordinary wards of poorhouses, does he not say that the ^^ majority^'
are "idiotic and demented,^' and does he not also say that "the
idiotic and demented patients in those houses are placed in as
favqrable conditions of existence as is necessary for their well-
being ? " Does he anywhere point out that there is a fatal and
fundamental mistake in selecting these classes of the insane poor
for what he calls the more domestic treatment? He does this
nowhere, within my knowledge, and he certainly does not do
it in his address, till, beginning to speak about Scotland, he
writes as follows : — " I would just ask you to recall the demented
and fatuous inmates of one of our county asylums, with their
depraved habits and many wants, and to remember the daily, hourly
care required to keep them decently clean, and to retain some faint
image of humanity and civilisation about them, in order to realise
what their condition must be when all the costly remedial agents of
the asylum are once withdrawn.^' This, of course, is true of a cer-
tain number of the idiotic and demented ; but of some of them, is it
not a fact that little, or next to nothing of it is true — there being
many degrees and many forms of dementia and idiocy, some giving
great, and others but little difficulty in their management?

Dr. Eobertson does not propose to interfere with the present 6,638
single patients in England, unless by sending some patients out of
asylums, and so adding to their number. This crowd of single

aged in private dwellings, nor does it entirely exclude other forms of mental dis-
ease from sacli a mode of care and treatment. There are idiots, imhedles, and
dements, who require an asylnm for their proper care, and others who do not ;
and so also of the other forms of insanity. Bat the number of idiots, imbeciles,
and dements, who do not require this care, who can be comfortably and satisfkc-
torily provided for in private dwellings, and whose state is permanent and irre-
mediable, wiU always be and is considerable ; while of those labouring under the
other forms of insanity the number so situated wiU always be and is compa-
ratively smaU.

" The class, therefore, which my experience has shown to do best in private
dwellings is that class which it is often desirable to remove from asylums, either
to obtain space or to check excessive accumulations. • • • •" — Mghth Annual
Report of hootch Commission's in iMnacy, Appendix, p. 240.

* Journal of Mental Science, January, 1865, p. 478.

478 Tie Care and Treatment of the Ineane Poor; [Jan.^

patients, therefore^ will still connst ^'cliieflj of cases of idiocy and
dementia."

It will be fonnd^ also^ that Dr. Bobertson^ in objecting to the
idiotic and demented as proper classes for home treatment> omits to
tell us what the proper ones are; while, by clear inferences, he
actnallj gives his approval to the improper ones;

When the whole of his scheme becomes a reality, w^ shall have
in England 8,250 panper lunatics in private dweUings, and I venture
to pr^ict that it will be found, then as now> that the idiotic
and demented constitute the great majority.

II. Objection is taken to the fact that we have 28'5 per cent of
our pauper lunatics in Scotland in private dweUittgs, whicis it
seems, ought to be 15 per cent., as is now and ought ever to be
the case in England.

The history of the Scotch number is briefly this : — In 1855
there were 1363 single pauper patients, or 32 per cent, of all
pauper lunatics ; in 1859, under the operation of liie Lunacy Law,
the number had risen to 1877, being an increase of tnore than 500 ;
in 1866 the number had fallen to 1568, being still 200 above
the original number, but constituting only 28*5 per cent, of all
pauper lunatics. Of the original 1363 and the additional 514
whom the inquiries of the Board brought to light, a considerable
number were improperly kept in private dwellings, and were removed
to asylums at the instance of the Board.

Dr. Bobertson gives the proportion for England at 15 per cent.
He gives no reason whatever for adopting tfis iH'oportion except
that it is the one which presently exists. The 25 per cent, for poor-
houses he seems to recommend because it is and was, and the 15 per
cent, for private dwellings because it is and was not. Sic vold^ sic
jvheOy atet pro ratione voluntas,— on that footing we are to accept
these hard and fast lines, unpopular though such lines have lately
been, and inapplicable though they always are to questions of
medical and social science.

The operation of such a system as that under discussion is not
to be regulated by a prearranged per-centage. On the contrary,
the per-centage must be determined by the number of suitable
cases and the power of providing for them satisfactorily. AU those
patients whose well-being and happiness will be increased by being at
home, for whom a comfortable and safe provision can be found there,
and whom asylums cannot benefit, should be left at home or should
be sent there, whether their proportion to the whole number of the
pauper insane be 10, or 15, or 20 per cent. And in practice it
will always be found that the per-centage is one thing in one

1868.] hy Pe. Akthur Mitchell. 479

coimtry and another in another ; one thing even in 6ne parish and
another in another; and such diflferences will be proper ones,
arising sometimes from accidental causes, and sometimes from causes
of more fixity or permanence, such, for instance, as may be involved
in the habits or in the circumstances of the people.

I have before me the pubUshed report of a country parish,
liable for the maintenance of 18 lunatics, who are as 1 to 232 of
the population. Of these patients 9 are in asylums and 9 in
private dweUings, that is, 50 instead of 15 per cent. A variety of
circumstances combine to bring this about and to make thmgs
possible in that parish which are impossible in others almost adjoin-
ing.* For example, 9 of the 18 patients happen to be suitable ;
relatives and friends of the patients, with comfortable homes, are
found wilUng to be guardians ; the Parochial Board takes a liberal
view of its obligations in these cases; the medical oiBBcer and
inspector of the poor are interested in making arrangements
to satisfy the Board of Lunacy ; and the circumstances and
occupations of the people of the parish are favorable. All these
and other things combine to give the result I have stated, but if
any one or two of them were changed we should immediately have a
different result, reducing the proportion, perhaps, even below 16
per cent.

This same parish furnishes in another way an illustration of
how widely the operation of the system may be influenced by
local and other causes. One of the nine patients left at home was
at first regarded as of doubtful suitability, but a weD -considered and
liberal arrangement for her comfort and safety was made by the
parish, and for many years she has done well. In other words, the
very range of suitability seems capable of being widened by good
management.

As yet, indeed, we know little of the extent to which the system
may and should be worked ; 15 per cent, may be found generally
too high, while, on the other hand, it may be found safe to go as far
as 80 per cent., or beyond it. Very much will depend on the spirit
and way in which the trial is inade. Where failure is desired there
will not be much chance of success. It will be very easy, indeed, to
secure failure, if that is wanted, for even the most earnest and honest
desire after good results will assuredly encounter at the outset a
multitude of difliculties and discouragements, which will neither
soon nor easily be removed. Hitherto in no country has a
full and fair trial been made. More, however, has been done
in Scotland than anywhere else, though the difftculties and hin-
drances there have not been few. Still more, I trust, will yet

* In the very next parish, out of five patients in private dweUings four were
removed by the Board to an asylam.

480 TAe Care and Treatment of tie Insane Poor; [Jan.^

be done^ since already the general result leaves no doubt as to
the propriety of allowing a certain number of the insane poor
to remain at home^ and as to the possibility of increasing their
number. It will be difficulty indeed^ to say that we have reached the
limit so long as there is one " harmless and incurable'' patient in an
asylum^ whose removal to his home would be productive of '' in-
creased enjoyment of life/'

UI. ^^The amount of the official inspection they receive cannot
be worth much." This is what Dr. Bobertson says of the single
patients in Scotland^ and he goes on to describe the nature of that
inspection^ but not quite so correctly as I think I shall be able to do.

'' Patients in private dwellings are visited by a medical man at
such intervals as the Board shafi determine ; and it is directed that
at each visit an entry shall be made in a book^ kept in the house for
the purpose^ of the date of each visits and of the mental and bodily
condition in which the lunatic was found. As a rule, these visits
are required by the Board once a quarter. By the Poor Law Act it
is further provided that every pauper shall, unless under certain ex-
ceptional circumstances, be visitol at least twice a year by the
inspector of poor or his substitute. By the authority of the
Board, every patient in a private dwelling is directed to be visited
by one of the Commissioners or Deputy-Commissioners once in
every year, unless such dwelling shall be situated in Orkney or
Shetland, or the Western Islands, when, owing to the difficulty of
communication, a biennial visit only is. required."^

In exceptional cases, the visit of the parochial medical officer
may be ordered to be made monthly or fortnightly. In like
cases the visits of the Commissioners or Deputy-Commissioners
may be two, three, four, or five in a year. In addition to these
official visits, there is also that daily and constant inspection which
arises from the fact that every one going into or passing the
cottage in which the patient resides, sees him, and care is taken
that he is such a one as this may be true of. The selection is
made with the knowledge, in the first place, that the Board may
order his removal to an asylum if the guarantees for proper treat-
ment be not deemed satisfactory, or if it be thought that asylum
treatment will promote recovery or improvement ; and, in the second
place, that after such removal has been ordered, the patient cannot
be taken off the poor roll without the Board's consent. This
knowledge tends to prevent, on the part of the local authorities,
such a selection of patients, or such arrangements for their keepings

* Ninth Report of Scotch Board, xiux.

1868.] iy Dr. Arthur Mitchell. 481

as they expect to find condemned, since this would involve them in
a twofold trouble. Considerable importance is always attached to
the fact that the patient is in such a state as will permit of his going
in and out of the cottage in which he resides, at his own pleasure and
like any of its other occupants, — so that there may be thus secured
the inspection of neighbours, which, though not oflBcial, is of
undoubted value. As regards the visits of the Commissioners or
Deputy-Commissioners, there are patients for whose safety and
comfort provision has been made of so satisfactory and sure a
character that the annual visit may be, and occasionally is omitted,
without fear of consequetot injury to the patient. There are other
patients, again, whom it would be desirable to visit, and who are
visited, oftener than once a year.

Whether worth little or much, I think this correctly describes the
general nature of the inspection and of the guarantees for the
proper care and treatment of the single patients in Scotland. If
these be of little value, they are still surely of more than the inspec-
tion which is recommended for the 15 per cent, in England, and
which I shall give in Dr. Eobertson's words : — ^^ The medical
practitioners in the district should be employed to make a quarterly
medical report to the visitors, and, in exceptional cases, farther
visitation could be made by the medical officers of the county
asylum.'' The inconsistency here is remarkable. I have made one
omission, however ; there is also '' a periodical visit*' by a reliemtg
officer, who is to be added to the staff of the asylum.

This relieving officer, or the medical superintendent of the county
asylum, according to Dr. Bobertson, is to fix the allowance given to
the guardians of the patient for his maintenance, and this allowance
is not to exceed the asylum rate. This refers only to those
patients who have been in asylums, and his ^'machinery" does not
in any way reach the great mc^ority of single patients, who have
never been there, I do not know how he would deal with them, or
with the cases of those patients who only require aid from the
public while in asylums, and whose friends are willing and quite able
to support them at home. Between such cases and those in which
the whole maintenance of the patient must be provided by the
public, wherever he is, there occur all gradations. The dealing with
questions of this kind, and the dealing with them arbitrarily, would
be a peculiar and difficult part of the duties of an asylum physician.
He would have to sift the claims of appUcants for parochial aid and
inquire into their circumstances, and he would have to reject these
claims, or fix their extent if he thought them established. This
would be somewhat difficult, even in the cases of patients who have
been in asylums and who are allowed to return from them to their
homes uju-ecovered, for Dr. Bobertson himself says that some

482 The Cote and Treabmend of tie Insane Poor ; [Jan.,

patients obtain admission into these asylums by evading the re-
strictions of the Poor Law. Bat if difBcnlt with this class of
patients^ what woold it not be with tAose who have never been in
a9i/lumsy who are always the great majority ^ and many of whom
reside with their friends in districts remote from those to which they
are chargeable ?

From the sentence following those in which this scheme is pro-
posed we gather that Dr. Bobertson looks on all single patients as
having been in an asylum, whereas it is and always will, and must
be true of a great majority of them that they have never been
there. He seems perpetuaUy to lose sight of this, or to be imorant
of it, whether he sp^ks of the single patients of England or of
Scotland.

In the latter country, every lunatic becoming chargeable to a parish
must either be removed to the asylum of his district, or dispensation
from removal must be granted by the Board, on an application from
the parochial authorities, accompanied by a statement of particulars
and a medical opinion as to the propriety of the step. The Board
afterwards, through one of its own members or officers, ascertains
by personal inspection that this dispensation has not been impro-
erly applied for or granted; and the knowledge that this will
e done tends to prevent improper applications. In Scotland;
70 to 80 per cent, of the pauper patients in private dwellings
have not been in any asylum, being in such a state at the time of
becoming chargeable, as to make that step unnecessary. It is the
object of the Board to secure that the single patients consist of
a properly-selected class, and that their safety and comfort are
reasonably provided for; and that this double object is possible
and has been practically attained there is evidence in these two facts-—
1st, that witn an average number of between 1,600 and 1,700
there has been no suicide or dangerous assault during ten years;
and 2nd, that the yearly mortahty has maintained throughout a
remarkably low figure, being at its highest 6*4 per cent., at its
lowest 4*5 per cent., and on an average about 5*2 per cent. These
two facts cannot fail to carry weight, and they go far of themselves
to justify the recommendation of the Board as to the propriety of
providing for a certain class of the insane poor in private dwellings.
This recommendation appears to me to rest chiefly on the following
reasons:

First. Because it is an act of justice and humanity to that class
of patients whose enjoyment of life, as Dr. Bobertson says, it will
increase, who are ^^ incurable and harmless,^^ and whose treatment in
an asylum would, as he also says, '^ be a ipatter of organized system
rather than of individual observation.^'

Secondly. Because, being more economical and not injurious to

1868.] iy Db. Abthub MiTCHiiiiL. 483

ihe patients^ it is but fair and right to the ratepayers^ since
the support of the insane poor, while a duty, is also a charity,
and is only one of many hke duties which we are bound to dis-
charge.

Thirdly. Because, by practising economy, where it is possible to
do so without injury to the objects of our charity, we obtain the
means of giving aid to other sufferers, and among these to other
lunatics.

If it were generally known, as well as it is to me from the
nature of my duties, how many insane persons there are on the
confines of pauperism, whose claim for public aid is rejected,
chiefly for the reason that lunacy is already felt to be an oppressive
burden, the increase of which is studiously avoided, this considera-
tion would not be lightly passed over, by those at least w&ose
desire is the greatest good of the greatest number. After a time
such applicants for relief cross the Bubicon, and come unmis-
takeably within the region of pauperism ; but rehef is then given
when it is comparatively useless, and when the disease is fairly con-
firmed.

Fourthly. Because it would strengthen the confidence of the
poor in the authorities of the asylum, as Dr. Eobertson well
puts it.

There are many cases in which the friends of patients refuse
relief when offered, because the accepting it would involve removal
to an asylum, which they regard as a separation unto death. I
know many instances in which extraordinary struggles have been
made, painful privations endured, and cruel restraints imposed on
the patiisnt, in order to prevent removal to an asylum from which
they expect no return.

We know the number of pauper patients who leave our asylums
cured. We are constantly regretting its smallness, and properly
complaining that so many of those who enter the asylums are already
in a hopeless state of £sease. If, then, in addition to those who
leave them cured, but few others leave them unless on their way to
the grave,^ we cannot marvel much at these mistaken views on
the part of the people. And if these views can be corrected without
injury to any of the insane, — ^if the confidence of the poor in the
authorities of the asylum can be strengthened, as Dr. Eobertson
thinks, by returning to their homes a certain number of unrecovered
patifents, — that should certainly be done, if possible.

* The difil^nce between the discharges of unrecov&red private paiiienit and
vnrecovered pauper paHenis is always exceedingly great, so great as to force ns to
the condnsion either that many private patients are improperly discharged, or
many panper patients unnecessarily detained. This point is one of much practical
importence, and deserves careful investigation.

484 Tie Care and Treatment of tie Ineane Poor ; [Jan.^

Fifthly. Because it is thoagbt that the operation of this system
will tend to establish 'Hhe medical character of the asylums as
hospitals for the cure of mental disease.'^ *

No words are needed to recommend this. The first and highest
aim of an asylum is the cure of those labouring under mental
disease — a disease so frequently requiring in its treatment those
special appliances which the homes of the rich cannot furnish, and
still less the homes of the poor. It is the second aim of an
asylum to provide for the safe keeping of those lunatics who are
dangerous to themselves or others^ irrespective of curability, and
to provide also for the comfortable keeping of those who, though
not dangerous and not curable, are in such a state from their dis-
ease as to make it difficult, if not impossible, to provide properly for
their peculiar needs, anywhere but m a special institution. When
asylums pass these two aims they exceed their proper functions,
and they do this to the injury of the whole body of the insane
poor. That there is a feeling that these aims are being passed,
and that an injury to the deepest interests of the insane poor is
being thus done, recent writings on lunacy supply good evidence.
I have only before me just now the last number of the Journal of
Mental Science, and I find in it a quotation, made by Dr. Eobertson,
from Maudsley's most able work on the ' Physiology and Pathology
of the Mind,' in which he speaks strongly and clearly of the desira-
bility of lessening the sequestration of the insane, and of allowing
many of the harmless and incurable to spend their days in private
families, with the comforts of family life and the blessings of the
utmost freedom that is compatible with their proper care. He tells
us that he thinks the future progress in the improvement of the
treatment of the insane lies in this direction, and he goes on to say
that when it has been found possible to act on such views, "then
will asylums, instead of being vast receptacles for the conceahnent
and safe keeping of lunacy, acquire more and more the character of
hospitals for the insane ; while those who superintend them, being
able to give more time and attention to the scientific study of
insanity and to the means of its treatment, will no longer be open
to the reproach of forgetting their character as physicians,
and degenerating into mere house stewards, farmers, or secre-
taries.*'

In the very same number of the Journal we also find Dr. Davejr
saying that asylums like those at Hanwell and Colney HatA, by
their magnitude and arrangements, are not adapted to the cure of
mental disease, and should be regarded as places for the mere pro-
tection and care, day by day, of the irremediably mad.

* Dr. Robertson, op. dt., p. 6.

1868.] hy Dr. Aethur Mitchell. 485

In their last report the English Commissioners, when speaking
of chronic patients in asylums, say, '^A patient in this state
requires a place of refuge ; hut his disease being beyond the reach
of medical skill, it is quite evident that he should be removed from
asylums instituted for the cure of insanity in order to make room for
others whose cases have not yet become hopeless ;" and they say
further that the removal of such patients will render ^^ the present
asylums effective for the reception of curable cases, and such as
require special care."

The effects of such a withdrawal of chronic cases on the functions
of asylums wiU be the same, whether the patients are sent to
poorhouses or to private dwellings; it will enable the asylums to
receive the two classes — tAe curable, and mch as require special
care — and will tend to establish their medical character.

So much for the grounds on which I imderstand the Scotch system
to repose. I am alone and personally responsible for all here said,
but I regard myself as merely expressing, in my own way, what
has been laid down in or what may be deduced from the reports
of the Board, with which my opinions are in close accord.

The general recommendations of the Scotch Board seem to me
to spring from reasons which are sound and unassailable. With
this object in view — the greatest good of the greatest number —
they appear to be offered; and what are they, after all, but an
extension of that non^estraint which is the boast of this land and
the glory of ConoUy ? It is a necessary effect of what he introduced,
that the character of asylum populations should somewhat change,
and also that the very number of those who are classed as the insane
should be somewhat widened. Hence comes a- new state of things,
of the growing existence of which I believe all are conscious, though
some may be unwiUing to acknowledge it, and though there
may be differences as to those other new things in which the
redress is to be found. The recommendation to provide for a
certain number of the insane in private dwellings may be regarded
as an extension and a product of non-restraint, and it is so in the sense
just indicated, but it is so in a still more literal sense; for if there
be in an asylum an " incurable and harmless lunatic,'' whose " en-
joyment of life would be increased '' by a return to his friends, is
not his detention ^ in the asylum a restraint, and should not efforts
be made to bring it to an end, and to place him in those circumstances
which will best promote his happiness ?

The efforts which have been made, and the discussion which has
taken place as to the management of a certain number of the insane
poor in private dwellings, and as to the condition and treatment of

* It is desirable always, but difficult sometimes, to avoid the use of snch words
as detention, confinement, &c., with reference to patients in asylums, because, as
reg^ards some cases Dr. Robertson refers to, they are, perhaps, the proper words.

VOL, xin ^4

486 Tke Care and TreaimetU of the Luame Poors [Jan.|

the insane at Gheel, have ahreadj borne fruit. There are few men
deaUng with insanity whose opinions have not through this source
undergone some modification^ and the fruit is further to.l^ de-
tected in the management and construction of many an asylum^ and
in the strength and width which have been given to the great prin-
ciple of non-restraint.

lY. Dr. Bobertson seems to object to the fact that in Scotland
'^ the care and treatment of the insane poor in private dwellings is
carried out under the official authority of the Lunacy Board. If
his plan were adopted^ the single patients of England would be
under the entire control of the visitors and medical superintendents
of the county asjrlums^ and the English Commissioners in Lunacy
would know nothing about them^ ana have nothing to do with them.

With reference to this^ I have only to say that I think the Scotch
plan incomparably the better one^ and for tms opinion I have already
given reasons which appear to me good and sufficient.

He also objects to the various ways in which the Scoteh Board
can dispose of pauper patients in private dwellings ; but a responsible
body like the Commissioners in Lunacy cannot in such a matter
have powers which are too wide. They are only required to exercise
them where they think proper^ and it is surely an advantage that
they do not find themselves unable to give their sanction to any
arrangement which makes a satisfactory provision for the comfort
and safety of the patient. The circumstances of different patients
are so varied^ that there should be no l^al prohibition to any
arrangement which commands approval; and there should be such
confidence in a body like the Board of Lunacy as will result in its
having permissive powers of as wide a character as possible.

The different ways in which pauper patients in Scotland can be
legally provided for in private dwellings are as follows : —

Per-centage of patients in pnrate
cKreUings (StnUand) disposed
of in the different ways.

1. With their relatives as guardians 75-5

2. With persons as guardians who are not relatives —

there being only one patient in the honse 21*1

* 3. With persons as guardians who (as in No. 2) are not
relatives, but who have obtained from the Board a
special licence, and who may, according to the Board's
approval, receive either one, two, three, or four
patients 8*4

The first and second methods are in operation in England as well
as in Scotland; the last is in operation only in Scotland. But
there, as in England, the great majority of persons in private dwell-
ings are under the «are of relatives. Readers of the address, how-

1868.] by De. Aethur Mitchell. 487

ever, will think that this is altogether otherwise. Wherever suitable
guardians can be found in relatives, these are chosen in preference
to strangers, and accordingly we have 75*5 per cent, of the single
patients boarded with their friends. The remaining 24*5 per cent,
embraces those who live singly with persons not related to them, and
those also who are in houses with special licences for two, three, or
four. These last are but a small number, being in all 53 patients,
and forming only 3*4 per cent, of the whole.

This statement changes entirely the aspect of the case which is
presented in the address.

It naturally occurs here to inquire if in these respects the position
of the single patients in England differs essentially from that of the
single patients in Scotland.

There are in England 6638 pauper lunatics in private dwellings.
These constitute the 15 per cent, approved of by Dr. Robertson, and
it appears that 81*6 per cent, of them live with relatives, and 18*4
per cent, of them with strangers,'*^ These last all live singly, bo far
as we know. In Scotland a small number (53 patients) do not live
singly, but in twos or threes ; that is, — ^in a few instances, instead of
entrusting only one patient to a guardian, two or three are entrusted
to him. It is only, therefore, in reference to these fifty-three patients
that Scotland differs from England. And even this difference,
which, after all, is a matter of degree rather than of kind, might
disappear if we knew as much about the single patients in England
as we do about those in Scotland.

It is true that the proportions of the patients under the care of
relatives and under the care of strangers differ in the two countries ;
but this does not affect the principle of *^ farming out,'^ which
appears from the address to hold only in Scotland, but which exists
also in England. Indeed, if you take absolute numbers, there are
in England 1221 patients so farmed out, and in Scotland only
384. All this is known to Dr. Bobertson, and some of it
exists almost under his eye. Yet he has no fault to find with
it there. It only becomes objectionable when north of Tweed, and
this appears the more inconsistent and unreasonable when it is
remembered that in Scotland great attention is paid to the insane
poor who are out of asylums, and earnest efforts are made to
improve their condition, while in England little of the kind is
done, there being no provision or machinery for the purpose.

The 6638 single patients in England are under the care of
boards of guardians and their officers, while in Scotland the 1568
single patients are under the direct and immediate control of the
Board of Lunacy, who have great powers in respect to them. In

* The proportions existing on Ist January, 1864, are here taken, as no other
figures are accessible. Since no influence has been at work to change the pro-
portions, they may be assumed to be substantiaUy correct.

488 The Care and TreaimeiU of the Insane Poor ; [Jan.,

Scotland their condition has been carefolly inquired into^ and is
well known. In England the address tells ns that but little is
known of their condition^ and that little not much to its credit. In
1865 Dr. Robertson wrote even more strong^^ and said that the
condition of the insane poor in private dwellings in England was
''most unsatisfactory/''^ and that these patients were ih^ '^in a
miserable plight.'' f

I scarcely think it is knowing little of their condition to know
this. If he be really correct^ such investigations as have been made
in Scotland might lead to like disclosures; and cases of n^ect,
misery^ and cruel restraint^ as shocking as anything ever found in
Scotland^ might be brought to light.

One effect of these inquiries would probably be that the number
6638 (a number which has been steadily increasing since 1847,
when it was 4418) would undergo a further and sudden rise.
This would result from its being found that some lunatics
were in private dwellings and in receipt of relief who were not
included in the 6638. The next thing, if the Board of Lunacy
had the proper powers and machinery^ would be the weeding out and
the sencQng to asylums of all unsuitable cases^ and a consequent
reduction of the number. Then would follow efforts in various
ways, as experience would teach, to make the condition of the
remainder as satisfactory as possible. In doing this, I am
sure that regret would be felt if, where two patients appeared to be
comfortably and satisfactorily provided for under one guardian, it
became necessary to disturb the arrangement because the law only
allowed one patient in each house.

The beneficence of such a system of control and inspection as is
here implied would soon be acknowledged, and it would quickly be
felt that it was necessary to the completion of the idea of a state
care of the insane poor, who require and have a right to that care,
wherever they are placed, whether in asylums, or in poorhouses, or
in private dwellings.

It would be a second but an important feature of the beneficence
of such a system, that it would enable the Board of Lunacy to
sanction and encourage the removal from asylums to their homes of
those ''incurable and harmless" patients, whose "enjoyment of life
would be increased " by such a procedure.

All this and more has been aimed at and attempted in Scotland,
whose lunacy law places the whole body of the insane poor under
the care of the State, whether they be in establishments or in private
dwellings. It fully and clearly recognises the latter class, and
assigns duties and gives powers to the Scotch Board regarding them.
Under these powers their condition has been carefully looked into,

* Journal of Mental Science, No. lil, p. 479.
t Ibid., p. 482.

1868.] by^ Dr. Aethur Mitchell. 489

and eflfbrts have been made to render it as satisfactory as possible,
and to see that none requiring the appliances of an asylum for
treatment or care are denied that advantage.

In no other country is the law so comprehensive. Nowhere else
in Europe is that saying of John Stuart Mill, which Dr. Robertson
has placed on the title-page of his address, made so fully a matter of
fact. ''Insane persons,'' says Mill, "are everywhere regarded as
proper objects of the care of the State,'' and this is acted on in Scot-
land to a larger extent than anywhere else. The Scotch law may
have defects ; but, taken as a whole, it is not only behind none, but
is in advance of all , and its promoters may well find pleasure in the
woA they accomplished. When it has been twenty years in opera-
tion I hope it will be able to point to achievements equaling those
already performed in England, which are regarded with as much
pride by the Scotch as they are by the English, and which are less
the triumph [of a nation than the triumph of enlightenment and
humanity.

V. Dr. Eobertson's remarks lead his readers to suppose that a
very large number, if not all the pauper patients in private dwelliiigs
in Scotland, are under the care of those who have a special licence
from the Lunacy Board to receive two, three, or four patients. The
fact is, as I have stated, that only 3*4 per cent, of the whole single
patients are thus disposed of. What their number will eventually
be it is neither possible nor proper to predict. When suitable
guardians can be found in relatives these will generally be chosen,
and there is good reason for beheving that the majority of single

Eatients will always, as now, be found under the care of friends ;
ut there are certain patients who have no friends at all, and yet
who are harmless and incurable, and belong to the class whose en-
joyment of life is increased by being out of the asylum ; there are
others, in the same condition, who have friends, but whose friends
are not trustworthy, or are otherwise not suitable as guardians;
there are others, again, also in the same condition, whose mental
stat« has such peculiarities as to make absence from home and
friends, though not detention in an asylum, desirable as a means of
promoting their happiness and wellbeing. For these, and for other
patients in like circumstances, it is certainly a proper thing that
the Board of Lunacy should have the power, given by the Scotch
law, of sanctioning whatever arrangements inquiry shows to be satis-
factory.

Dr. Robertson bestows various epithets ou the persons who are
thus approved of by the Board as guardians. He calls them
* 'ignorant and needy ^^ for instance. I cannot call them learned and
affluent, but I am able to state that they belong to the respectable

490 Tke Care and Treatment of the Insane Poor ; [Jan.,

working class^ and this I r^rd as sufficient. I am able also to state
that they are less ignorant and less needy than many or most of
those relatives of patients who are approved of as goarmans both by
Dr. Robertson and by the Board of Lunacy^ and that they are certainly
not more ignorant and needy than the class which yields the male
and female attendants in asymms. Omitting the ignorance, and re-
marking only on the neediness, I have furtiier to point out that,
even in the case in which an approved-of guardian takes charge of
two pauper patients solely and entirely for the reason that it will be
of advantage to him, it is not necessanr that he shall be needy in
any other sense than would be applicable to a carpenter who under-
takes to make a table, or to a surgeon who undertakes to reduce a dis-
location. It should be borne in mind, however, that many guardians
who are classed as strangers because they are not relatives, are, in
reality, connected to the patients by old acquaintanee and friendship,
for the sake of which they agree to receive them into their famiUes,
and undertake the care of them, though unable to do this without
remuneration.

Another epithet which Dr. Robertson appUes to these persons is
that of '' lay speculators in lunacy .''

With r^ard to this, I wish, firsts to point oat that it must wpfij
as much to those guardians receiving patients singly and not related
to them, as it does to those who receive them in twos or threes,
and it therefore appUes to 18*4 per cent, of the single patients in
England ; but we hear nothing of speculators there, though it
appears that they are 1221 in number against 884 in Scotland.

But Dr. Robertson does not simply call these persons " specula-
tors in lunacy.^' He calls them " lay speculators in lunacy.^' Twice
he uses the epithet lay — once as "lay speculation^' and once as
"lay speculators,*' and in the last case he prefixes the word
humble.

What he understands by the word lay I cannot tell. In English
I believe it never bears any other meaning than not clerical, and
refers always to the people as apart from the clergy. It comes to
us in that sense, I think, from the old church^latin.

It would be nonsense, however, to suppose that in the address
it is used as meaning that the speculators are objectionable because
they do not belong to the clergy ; and the word cannot stand for
non-professional or non-medical. Nor can we suppose that its use
implies that any sort of speculation in lunacy is allowable. In
sliort, I am unable to declare its meaning, yet it may not be without
significance.

VI. " It needed not,'' says Dr. Robertson, *' the graphic detail
given by the writer of an oft-quoted paper, ' Gheel in the North,'

1868.] hy Dr. Arthur Mitchell. 491

to realised how far removed from sober truth are the pictures of rural

bliss which are yearly ohronicled in the appendix to the

Scotch Lunacy Cotamissioners' reports.^'

Since this anonymous testimony was not needed, it follows that
nothing was needed, for we hear of nothing else, and we know of
nothing else. It has thus proved a very easy matter for Dr. Eobert-
son to arrive at the conclusion that these official documents are
departures from sober truth.

When Dr. Hbbertsori was in Scotland last year, why did he not
seek an opportunity of seeing and judging for himself? Why,
indeed, did he not come down to Scotland this year in quest of
opportunities of personal inquiry, to make sure of the accuracy of
such a statement before uttering it ? Since he has shown no wish
to obtain a personal knowledge of the state of matters in Scotland,
I now oifer him an vnmtation to come and see.

All those documents which are described in this address as
departures from sober truth I know to have been written with a
desire to be accurate and fair; and I am hopeful that it will be the
opinion generally of those who read them that they give evidence of
this. In the January number for the present year of ^'^ Journal
of Mental Science, it may be remembered that there is a review
which speaks favorably of the more recent of these reports, and
applies to them such adjectives as " calm and temperate.'^ In that
review the writers of these reports are spoken of as those '' entrusted
to carry out the policy of the Board with regard to single patients,'^
and it is further said that ^ it is evidently not the aim of the Scotch
Board to place every class of the insane poor in district or other
asylums, but rather to secure the co-operation of the parochial
authorities for the satisfactory care of some of them in private
dwellings.'* Eeference to the annual reports of the Board, which
are signed by all the Commissioners, will show the accuracy of these
statements.

The object in using such a phrase as '' pictures of rural bliss^' it
is not difficult to understand. The intention, of course, is to be
damaging by overcolouring and exceeding what has really been
said, but this is not a judicious or eflFective proceeding in questions
which are sure of further sifting.

The application of the term " GheeP to the Scotch system has,
it appears to me, a like object, for the writer of the article must
be well aware that the term bears no special relation to anything
existing in Scotland.

In point of fact, there is a Gheel in the south, quite as correctly
as there is a Gheel in the north. In England there are 6638 pauper
lunatics in private dwellings, some of whom live with relatives and
some with strangers. In Scotland there are 1568 pauper lunatics
in private; dwellings, some of whom live with relatives and some

49)S TAe Care and Treatment of the Insane Poor; [Jan.,

with strangers. In England the great majority live with relatives^
and in Scotland this is slso the case. There is^ in shorty no differ-
ence between the two countries, except in the proportions of those
who Uve with relatives and with strangers.

All patients placed under the care of strangers may be said
to be kept for profit, whether they are so placed singly or in
twos or threes. The mode of placing them in houses licensed
for twos or threes has as yet but a limited operation in Scotland, and
embraces only 3*4 per cent, of the pauper patients in private dwell-
ings. The whole number of pauper patients so provided for is
fifty -three, and they are divided over thirty-four houses.* In one
village thirteen of these patients reside, in another ten, and in a third
five. The rest are scattered over the whole country, the Board
having had nothing whatever to do with the fixing of any of the
localities. The thmg as it stands is just the product of requirements
into facilities ; and small though the resultant seems, it has served
a useful purpose, and has been of benefit to a certain number of the
insane, who from various causes could not have been so benefited
but for the powers possessed by the Scotch Board. This little part
of the Scotch system is the only thing which more resembles Gheel
than what exists in England.

This is the actual and existing state of the case; but I have
to point out that GAeel in the north has no reference to these
houses with two, three, or four patients. Its author deals with
single patients — with a system, in short, which has an exact parallel
in England; and to this he applies the epithet of Oheel. The
many will not, and only the few will, detect the mistake and see its
bearing.

With further reference to Gheel in the norths I have only these
four things to state here :

(1) The impression which the article conveys is not a true
impression of the condition of the patients in private dwellings
in any part of Scotland with which I am acquainted, and it is far
from being a true one of their condition in those parts which are
under my own inspection.

(2) There is a remarkable use of figures in the article. One
of its features is this, that the same patient is made to appear over
and over again in the different categories, which are founded on
various bodily and mental conditions, and seem to embrace and
refer to different sets of patients. The effect of this I need not
point out.

(3) The article shows that no objection is taken to the condition
of a certain number of the patients.

(4) In such circumstances there is a quick and simple remedy,

* As the fifty-three patients are divided over thirty-fonr honses, it is evident
that in several there must be only one patient, and in the majority only two.

1868.] hy Da. Aethtje Mitchbll. 49S

which is as follows: — ^The removal to asylums of all the bad
cases.

This is what could be done, but that which practically would be
done is this : — ^The patients actually needing asylums for their proper
care and treatment would at once be ordered to be sent there ; those,
again, whose mental state did not absolutely require asylum care and
treatment, but whose condition was not satisfactory, would, in like
manner, be at once sent to asylums, if no hope of improvement at home
existed, but, if such hope existed, time would be given to effect the
improvement, and suitable recommendations thereanent would be
made. Where the patient was found suitable, and his condition
appeared to be satisfactory, there would, of course, be no disturbance
of the arrangement.

Vn. " There is Httle but the sixpence a day between them and
neglect and want/' So writes Dr. Robertson of the patients in
private dwellings in Scotland. How he knows this I cannot tell.
But if, as seems to be admitted, the sixpence a day does secure the
patients against neglect and want, why make it a shilling, or why
make it even sevenpence, or why, indeed, give anything beyond
what is found sufficient ?

Practically, the matter stands thus : — The friends or guardians of
some patients ask and require but little aid from the public, perhaps
only what will provide clothing \ the guardians of other patients
need more, and the allowance must be such as will cover food and
clothing; in other cases, again, it must be larger still, and the
whole maintenance of the patients must be provided, and some
remuneration given to their nurses or guardians. There is, and
there ought to be, a considerable range in the amount of the
parochial allowances. Each case should get what each case requires.
Between nothing and a large allowance, it would be an absurdity to
have no stage. From the person who is beyond the need of pubUc
aid, we go by a long succession of steps down to the person who
depends on it entirely. It matters nothing how cheaply a patient is
kept, if he be well kept — ^the cheaper, indeed, the better. It is the
result which concerns us, and if that be good and satisfactory, it is
no fault that the price is not a great one.

It so happens, and I speak from observation, that the condition
of a patient has no necessary relation to the amount of the allow-
ance in his case. In other words, he is not the better kept the
more he costs, any more than those are the best asylums whose rates
are the highest.

Sixpence a day is the average allowance for single patients in
Scotland, and this average results from allowances considerably
below and considerably above sixpence. Sixpence a day is also the

494 The Care and Treatment of the Insane Poor ; [Jaii.>

average allowance for single patients in England — ^for- both countries
the avera^ being thus the same. It does not follow^ however, that
sixpence m the two countries has the same value to the working
elass, and there are some reasons for thinking that a difference
exists* which would be in favour of the north.

It is, of course, a proper thing to endeavour to lead the parochial
authorities to take a correct and liberal view of the peculiar wants of the
insane, and in that direction much has been done in Scotland, where
the average yearly allowance to single patients has risen, since 1858,
from £7 11«. Id. to £9 10«. Id, But the requirements of each case
have always* been separately considered,^ and the recommendations
have never been made on any such assumption as that doubling the
allowance necessarily involved the doubling, or even the increasing
of the comfort and well-being of the patient.

With this I conclude the comments I have to make on the Presi-
dential Address, the subject of which is one of great and increasing
interest. My remarks have had reference only to one part of Dr.
Kobertson's scheme. In providing for the insane poor, asylums take the
place of first importance, and they do this in a very emphatic sense.
Poorhouses, or something analogous to poorhouses, and private
dwellings are merely supplementary. They complete the scheme,
and become necessary as part of a whole. For obvious reasons, the
need of these supplementary forms of providing for the insane poor
is increasingly felt, and they are consequently receiving more atten-
tion than formerly. In Scotland this greater attention has for a
considerable time been given to them, and with good results, both
as regards poorhouses and private dwellings. It is to the last,
however, that this communication almost exclusively refers, and I
have endeavoured to make it convey a correct view of what is
thought and done in Scotland in regard to the insane poor in

Erivate dwellings. From the nature of the communication, I have
een obliged to do this in a disjointed manner, necessitating repe-
titions, but this method sometimes has advantages, and may convey
clearer views than a systematic discussion.

I think all agree that it is desirable to ascertain the condition of
lunatics in private dwellings, to see that none are there who require
such care and treatment as an asylum only can furnish, and to see,
also, that a proper provision is made for the safety and comfort of
those whom residence in an asylum will not benefit. This is the
idea which underhes the so-called Scotch system.

Its soundness no one can question, since every one admits the

* Sixth Eeport of the Medical Officer of the Privy Council.

1868.] hy Dr. Abthue Mitchell. 495

propriety of extending the care of the State to the whole number of
the insane poor. . ;.

The system in no way or sense takes the place of asylums, being
me^rely.pne of the various wojs in which provision may be made for
the insane poor.

That the working of the system may afford relief to the accumu-
lation of chronic cases in asylums is certaiuc Of the extent to
which it may do this no one can yet speak with precision, but the ex-
perieipceof Scotland shows, that the extent may be one which is
quite appreciable.

If Dr. Bobertson discharges those unrecovered patients preseaally
in the Sussex County Asylam, whom he describes as incuinble and
harmless, and whose enjoyment of life, he says, will be increased by
removal from the asylum to their homes, there will be an immediate
relief, greater pr less, of course, according to the number of such
patients. Let us suppose that out of 530 he is able to discharge
only one dozen^ and that all other asylums can do the same ; we
should then have a total of 588 discharges, which is not an inap-
jfiectable number, since it surpasses the whole population of the
Sussex Asylum. But it would be a moderate estimate of the
patients in the condition he describes if we doubled the dozen,
which would give 1176 patients, and represent two county asylums
like Hayward^s Heath.*

There can be no doubt, however, that where a system Uke that
existing in Scotland is in full and active operation, many things are
possible which are scarcely so in the absence of such s ^ly^tem.
Asylum physicians, for instance, might have less hesitation in dis-
charging unrecovered patients if they knew that the interests of such
patients continued to be looked after, though they ceased to be
under asylum care.

The discharge of such unrecovered patients increases the happi-
ness and well-being of the patients themselves, gives pleasure to
their friends, confers a benefit on the country, and is an advantage to
the rest of the insane poor. This last is true even in a fuller sense
than has yet been stated. " The rapid way in which county asylums

* The moderatiou of this estimate will be evident from what follows, Ou the
1st of January, 1867, there were 24,748 panper patients in the county and borough
asylums of England, of whom 22,257 are declared incurable, and 2491 curable.
Of the incurable, 14,620 are declared excitable, violent, or dangerous, and 7637
are declared quiet and harmless. My large estimate, therefore, only deals with
about one seventh of the ineurctblcj quiet, and harmleMs,

It is worth remark here that of the 7637 who are incurable, and quiet, and
harmless, 4743 consist of the idiotic and demented,

Sussex asylum, however, shows 495 incurables in a population of 537 ; in other
words, it contains only 42 patients treated with the hope of cure. Of the 496
incurable, only 28 are regarded as quiet and harmless, and of these, 8 are idiots,
imbeciles, or dements.

496 The Care and Treatment of the Insane Poor. [Jan.,

are increasing in size, and the ever-recurring necessity of building
new ones/'* seriously interfere with the accomplishment of those
other schemes for the benefit of the great body of the insane, of
which we may dream, but which, under existing circumstances, we
need scarcely propose. Is there anything, for instance, more needed
than public asylums for the middle and lower middle classes P Could
the country fulfil a clearer duty or do a greater act of charity
than in providing them? Do we not require places where the
brothers, sisters, sons, and daughters, of doctors, and clergymen,
and lawyers, and schoolmasters, and people of such classes, may
find care and treatment, apart from ordinary pauper lunatics, but at
moderate rates ? Do we not even feel the need of some gratuitous
asylum provision for such persons? And do we not know how
much mischief and misery occur in the efforts to prevent the
sinking into pauperism of a member of a family which is quite
above the ordinary pauper class in its feelings, in its history, in
its social position, and in every sense, but which cannot meet a
continued yearly deduction of even £40 or £50 from its income ?

Do we not also need training institutions for young imbeciles,
and asylums for the care of the young who are degradedly idiotic ?
And should not these look for their origin and support to some
surer source than the voluntary contributions of the charitable ?

To approve of the disposal of a certain number of the insane
poor in private dweUings implies no narrow view of the claims of
the insane. On the contrary, I think it involves a comprehensive
benevolence in their regard, and the promotion of their best
interests. Such an opinion I believe to be held by a yearly
increasing number of men ; and the more the subject is investigated
the more do I think it will be acknowledged that a certain number
of the insane may properly be provided for in private dwellings, and
that such a procedure ^all, both immediately and remotely, be a
benefit to the insane. I have before me a letter from one of the
most distinguished asylum superintendents that England has of late

f)roduced, in which these words occur : — " I am surprised to find the
arge proportion of cases which may be most efficiently treated en
familley

For my own part, before changing the opinions I have been led to
form, I shall require more than the condemnation contained in
this address, especially as the author is at odds with himself.

In January, 1865, for instance, he published a paper '' On the
several means of providing for the yearly increase of pauper lunatics.''
He concludes that paper with a summary, showing that the increase
can for many years to come be provided for by what he calls "a

* Journal of Mental Science, No. xlvii, p. 362.

.1868.] Value of the Thernumeter in Diseases of Nervous System. 497

fair extension and adjustment of the existing system/' and the first
recommendation he makes is as follows : —

'* A limited number of the chronic lunatics who now occupy beds in
the public asylums may be placed as boarders, either singly or in
small licensed houses of four {as in Scotland), in their oum villages/'

In 1865, therefore, he recommends the adoption of that which in
1867 he calls a ''retrograde step in the care and treatment of the
insane/' In 1865 he recommends the introduction into England
of what, in 1867, he calls "the most objectionable form of lay
speculation in lunacy/' In 1865 he holds up Scotland for imita-
tion, and in 1867 he says he cannot cite the example of Scotland in
this matter as even worthy of consideration. If the advice given
by Dr. Eobertson in 1865 had been promptly acted on, and the
law had been changed as he proposed, I do not see how he could
have written one part of this address.

Clinical Cases illustrative of the value of the Thermometer as a
means of Diagnosis in Diseases of the Nervous System, By
F. W. Gibson, M.D. Lond., Resident Medical Officer, St.
Pancras Infirmary ; late Assistant Medical Officer, Criminal
Lunatic Asylum, Broadmoor.

Case 1.— S. E— , female. Admitted Jan. 22, 1866. Tried for
wounding, with intent to murder, Dec, 1865. Found insane. She
lived in a cellar with her husband and child. From the evidence
given at the trial and from her own account, it appears that she
wounded her child slightly with a razor in order to frighten her hus-
band, who had treated her with great cruelty, into better behaviour.
After she had been taken into custody it was found that " her mind
was much shaken, and that she was the subject of delusions."

State on admission. — Is in fair health ; suffers occasionally from
headache; no evidence of delusions; is quiet, and willing to work.

April 13th. — Behaving well ; employed in laundry.

28th. — Complains of pain in the right arm, and of headache.

29th. — Has been in bed all day, suffering from headache, pain
in the right arm, and from malaise; at eight o'clock was sick,
vomited matter, greenish ; afterwards she frothed at the mouth, and
became faint and cold. Seen by me at ten o'clock. She was found

* ' Joarnal of Mental Science^' No. lii, pp. 471—491.

498 Falue qftkt Tkefwmeter in DiseataiifUe . £Jan.j

to be '' lying on back in bed| moaning inarticalatelj^ fiace pale^ sikm
cold to tonch^ perspiring. Pulse 60^ feeble; respiration 2,0, not
stertorous ; heart'? action irregular ; pupils equals contracted,
sluggish. When spoken to she can be partially roused^ but gives
no intelligible answers to questions ; swallows with difficulty a httle
brandy ; when the skin of her feet is pinched she draws tip her
legs, and complains in a semi-articulate manner. Does not put out
her tongue when asked. 2 a.m. — Has been sick five or six times
since last report ; skin warm ; pulse 80, fuller, and more regular ;
slight twitches of right arm.

30th.— 11.45 a.m.— Pulse 120; resp. 40; temp. 101^°. She
is more unconscious. Pupils equal, contracted ; have been dilated
and contracted alternately. Paralysis of left side of face and of
left arm, accompanied, in the latter case, by rigidity of the
muscles. Bespiration stertorous, but not markedly ; no paralysis of
muscles of respiration, nor seemingly of any others than those named
above. 4 p.m. — Pulse 100 ; resp. 41 ; temp. 100°. No murmur
audible in cardiac region ; large-sized rdles all over left lung ante-
riorly. 6 p.m. — Pulse 1^0 ; resp. 32 ; temp. 102°. Passed water
voluntarily at 2 p.m.

May 1st.— 10.55 a.m.— Pulse 116 ; resp. 60; temp. 102°. Has
swallowed beef-tea and brandy during the night; moves both arms
sUghtly; sensibility in left leg minus; respiration stertorous; no
convulsions. 4.55 p.m. — ^Pulse 130; resp. 64; temp. 102^°..

2nd. — Died comatose at 9.45 a.m.

Autopsy, thirty hours after death, — ^Temp. of air, 40°, moist;
position of body since death, on back. Calvaria, nothing notable.
Dura mater, no adhesions to calvaria; small, pale, non-adherent
clot in superior longitudinal sinus. Pia mater strips easily from
convolutions. Gray matter of convolutions of cerebrum rather dark.
No atrophy. White matter of hemispheres, ventricles, central gan-
glia, pons, and medulla, healthy. Gsrebellum, right crus and floc-
culus much softened throughout ; colour not appreciably changed ;
the remainder of cerebellum healthy. Spinal cord, whole thidmess
in mid-dorsal region much softened ; just above lumbar enlargement
softening limited to white matter; the rest of cord healthy.

Microscopical appearance of softened ;parts, — ^Nerve-tubes broken
down; large cells containing numerous granules, and granular
state of nerve-cells; nothing abnormal discovered in vessels of
brain.

Organs of respiration and circnlation. — Nothing notable in
former; great contraction of tricuspid and mitral valves of heart
from atheromatous deposit; aorta healthy.

Organs of digestion, — Healthy.

GenitO'Urinary organs, — ^Eight supra-renal capsule converted into

186S.] HbnfomJ^Om ; fy Db. F. W/ Gibsok. 499

aqrst; lachieysgraniilar and shrunken; bladder, uteras, and ovaries,
hemfaj.

The case of S. B — presents many very interesting features.

1. Softening of the cms cerebelli, unaccompanied by any lesion
of the remainder of the enoephalon, is, I believe, very rare. I cannot
find any record of a similar example in the books to which I have
access at present. Notable is the absence of any of the phenomena
produced oy the section of the crus in the well-known experiments
of Magendie, Longet and Schiff, and Muller, on pigeons.

The cerebellum most persistently and perversely offers to the
physiologist pathological facts strangely adverse to his favorite
theories.

2. Notable likewise is the considerable power of motion in the
lower limbs, in spite of the large amount of lesion in the spinal
cord. That a woman whose cord is found after death to be soft-
ened throughout should be able, a few hours before that event,
voluntarily to draw up her legs in the bed, is unusual, but can be
accounted for; most probably a small strand of nervous fibres re-
mained unbroken until a short time before death, and that this
sufficed to carry a feeble volitional stimulus.

The combination of tricuspid constriction, itself no common dis-
order, with mitral constriction, is of sufficient rarity to merit a pass-
ing notice, even in the pages of a psychological journal.

3. The difficulty in the diagnosis between cerebral hsemorrhage
and acute cerebral softening is so great, that many have declared
that it is in some cases impossible. I should not be justified in
stating that the problem can always be solved by means of the
thermometer ; but I may venture, I think, to say that it is a valuable
means to that end, for in all cases of the former disorder where I
have made thermometric observations I have found elevation, in
those of the latter no elevation, of temperature.

I am glad to be able to add that Dr. Einger, a far more expe-
rienced observer than I am, informs me that he has arrived at a
similar conclusion as to the non-elevation of temperature in cases of
cerebral hsemorrhage. Absence of elevation of temperature above
the normal standard would be predicted from hjpriori reasoning in
such cases. If inflammation in the neighbourhood of a haemorrhagic
nidus ensue, the case becomes virtually one of abscess of the brain,
and, of course, like abscesses in other parts of the body, is accom-
panied by elevation of temperature above the normal standard.*

Case 2. — S, S — , male; set. 55. Admitted Nov., 1864.

f Since the MS. was sent to press I have seen a case in which the temperature
was lOV*, which was proved hy post mortem examination to he one of hsemorrhage
into the arachnoid and pons, without any complication.

500 Fatue of the Thermometer in Diieases if ike [JaiL,

History. — ^Tried at Chester, in 1854, for arson. Fonnd insane*
Sent to Chester Asylum, and thence to Broadmoor.

State on admission, — ^Dulness and feeble inspiration in left
clavicular and infra-clavicular r^ons ; no abnormal cardiac signs ;
no hemiplegia, but speech rather indistinct.

Mental state, — Memory defective ; answers simple questions cor-
rectly, but with hesitation. Says that the farmer whose stacks be
*' fired *' was always "making game of him," and that he fired them
to spite him. Expression of face that of a minus condition of intel*
ligence. Gives no evidence of delusion.

His state remained much as above until August 6th, 1867, at
which date the following notes were taken :

At 4 o'clock in the afternoon of that day he had an attack of
vomiting, and felt faint. He said that some one had knocked his
legs from under him. He was sent to bed, out of which he fell,
striking his head, and inflicting a slight scalp wound. 8 p.m. — Pulse
64 ; resp. 20 ; temp. 98°. Semi-conscious ; paralysis of muscles
on right side of face ; of right arm and leg ; none of muscles of chest,
even on deep inspiration ; pupils equal ; no paralysis of muades (rf
palate; slight paralysis of muscles of jaw on right side; tongue
points to right side when protruded; no rigidity of muscles on
right side, nor loss of sensation (consciousness had returned when
test was apphed) ; no twitches ; no convulsions.

August 7th, a.m. — ^Pulse 60; resp. 16; temp. 98°. Paralysis
continues, but is less. p.m. — Pulse 84 ; resp. 16 ; temp. 98°.

8th, a.m. — Pulse 60; resp. 16; temp. 98°. p.m. — ^Pulse 64;
resp. 20; temp. 974°.

9th, p.m. — Pulse 60; resp. 16; temp, 98°.

19th, p.m. — ^Pulse 64; resp. 16; temp. 97-f-°. Paralysis nearly
gone. He is now much in his usual state.

That the case of S. S — was one of cerebral hsemorrhage I have
no doubt, although my diagnosis was fortunately not confirmed by
post-mortem evidence. The amount of bleeding was certainly small;
its site probably near the pons. This case does not exhibit any
peculiarly interesting phenomena, and I quote it merely to show
that the temperature remained, as in all the cases of hsemorrhage into
the brain of which I have notes, normal throughout the course of the
attack. To meet any objections which may be raised on the score of
the absence of post-mortem proof of the correctness of my diagnosis,
1 may state* that no elevation of temperature has been observed in
cases where such proof has not been wanting. The subjective and
objective symptoms in cases of hsemorrhagic apoplexv may be such
as to induce the non-thermometric observer to believe that the

* On the authority of Dr. Binger.

1868.] Nervous System ; by Dr. F. W. Gibson. 501

temperature is abnormaUy high, e.g., a woman, set. 72, during
recovery from such an attack, continually complained to me that
she felt as if she were ^' roasted alive ;'' her face was flushed, and
her skin felt hot. Nevertheless the temperature remained normal
throughout.

Case 3.— P. W — , male, set. 40. Admitted February, 1865.

History. — ^Tried at Leicester Assizes in 1862. Found insane.
Supposed causes of insanity, epilepsy and intemperance. Sent to
Fisherton Asylum in August, 1862 ; thence to Broadmoor.

State on admission. — Dulness, and jerking inspiration at right
apex ; no abnormal cardiac signs ; pupils equal ; partial paralysis
of muscles on right side of face, and of right arm and right leg.
When spoken to he at once begins to thump himself with his left
hand, and calls out, '^ Thank God V' "Thank the Lord V' and con-
tinues so to do as long as he is watched. He remained much in
the same state up to the time at which the observations recorded
below were made; he never uttered any words, save the above
named ; the paralysis did not increase. He had attacks of epilepti-
form convulsions in 1865, on May 8th, Oct, 3rd; in 1866, on
Oct. 3rd, Nov 6th, Dec. 28th.

July 1st, 1867. — At 8 p.m. I was called to see him by the
attendant in charge of the ward, because he was in a fit. When
I arrived I found him recovering, and his condition to be as
follows :

In bed, covered up, lying on back (went to bed at 7 "30 p.m.).
Pulse, 120; resp., 24; temp., 97°. Semi-conscious; twitches of
muscles of face on right side; two slight fits between 8 and 8.15.
8.15, — ^Pulse, 120 ; resp., 24; temp., 98°. Avery severe fit, begin-
ning by tonic spasm of the muscles on the left side of the body ;
head drawn forwards and to left; left fist clenched; arm flexed;
trunk raised from bed, and curved to left ; face livid ; fit began by
a deep inspiration or semi-articulate cry ; consciousness lost imme-
diately. The tonic spasm lasted about four seconds (he then fell
back in bed), and was followed by clonic convulsions of muscles of
right side of face, arm, and leg ; none of left. Sweat in beads on
left side of face, none on right ; face livid ; right eye buried under
upper and outer angle of upper eyelid ; left slightly turned to right ;
pupils equal, rather dilated ; conjunctivae pale. 8.20. — Pulse, 100;
resp., 24; temp., 101°. Temp, in left axilla, 101° ; in right, 101°.
Convulsions lasted in their full severity for four minutes, but twitches
continued for eight. 8.30. — ^Pulse, 100; resp., 32; temp., 101°.
Consciousness partly returned; face became red, instead of being
livid; he passed his left hand over his face, but did not speak.
Three slighter attacks; the last at 8.45. 9.10. — Pulse, 104; resp.
24; temp., 98°. 9 p.m. — Is now quite conscious; cried out,

VOL. xin. 35

502 Value of He Thermomet^ in Diseases of the [Jan.^

" Thank God ! thank the Lord V directly he became so. No more
observations with the thermometer can be taken.

July 2nd. — Is much in his usual condition this morning.

The phenomenon of the gradual rise and decline of the tempera-
ture, joanjoflw^tt with the increase and diminution of the severity of
the convulsions in this case, might serve as a groundwork on which
to build a theory, connecting the etiology of convulsions with that
of rigors, were it not for the existence of the fact that in other
cases of convulsions (excluding those occurring in the course of
acute specific diseases) there is no abnormal rise of temperature.
What was the cause of the rise in this case ? Without attempting
to reply to this question, which I think cannot be satisfactorily
answered at present, I venture to quote some remarks which I
made on a case similar to the above, of which a report was pub-
lished in the 'British Medical Journal,' Dec. 15th, 1866 :

" The researches of Claude Bernard have proved that irritation of the
cerebro-spinal system of nerves, by paralysing the sympathetic, pro-
duces dilatation of the minute vessels, increased heat, and augmented
chemical action. The phenomena in this case would appear at first
sight to be satisfactorily accounted for thus : Here is irritation of
the cerebro-spinal system, as shown by the convulsions, producing
increased heat and increased flow of the cutaneous secretion, but on
the other hand the phenomena of the convulsive attacks of epilepsy
are a direct contradiction of this theory, for while in these attacks
there is, as I think I may affirm as the result of very numerous observa-
tions, no increase of temperature, there is irritation of the sympa-
thetic, causing contraction of the vessels ; hence the loss of
consciousness, the pallor of the face, the small radial pulse, and the
dilation of the pupil.'^

The fear of wearying by the recital of examples alone hinders me
from giving any more than the practical conclusion which I think
may fairly be drawn from the data of my not very limited experience
in the use of the thermometer in cases of epileptiform convulsions.
It is this. The prognosis is very much more unfavourable in those
cases in which there exists abnormal elevation of temperature than
in those in which it is absent. Tlie value of the knowledge of the
fact that in uncomplicated epilepsy the temperature always remains
normal, is well illustrated by the case of a woman, aged 24, in
whom the elevation of temperature, during a series of convul-
sions, to 104^°, led me at once to suspect the presence of some
disease besides that of epilepsy, and, though there were no marked
symptoms pointing to pulmonary lesion, I found signs of tube^
cular mischief in both lungs, a diagnosis which was confirmed by
post-mortem evidence.

1868.J Nervom System; by Dr. F. W. Gibson. 503

Case 4. — ^T. M — y male, set. 37. Admitted May, 186i. From
Taunton Gaol. Tried March, 1864, for assault. Found insane.

State on admission. — Is rational. Says that at Christmas he
began to drink, and remembers nothing from the time he told his
wife everything was going round and asked her to hold him, until he
found himself in the county asylum. Eecollects nothing of the
assault.

July 17. — Has been behaving quite rationally until last night,
when he became very restless; walked about the dormitory, and
wound a sheet round his neck. Cut his. hands to be like Christ.

October 31st. — Is sujffering from a similar attack.

December 21st. — ^Ditto.

1866.— December 16th, February 11th.— Ditto.

June, 1867. — Some tremulousness of the facial muscles as he
speaks. Pupils of unequal size, the right being the larger.

July 1st. — Has been out of sorts for some days ; complains of
feeling cold. Paralysis of right facial. When spoken to, he begins
to talk at once, and rambles on in a most incoherent manner.
Tremor of muscles on left side of face. p.m. — Has been in bed
all day. Pulse 120 ; resp. 24 ; temp. 97-|°.

2na, a.m. — ^PulselOO; resp. 24; temp, 98°; head hot; pupils
irregular, dilated, right larger than left. Paralysis and tremor
continue. Is excitable and talkative ; incoherent, and has numerous
delusions, p.m. — Pulse 100 ; resp. 24 ; temp. 98°.

3rd, p.m. — Pulse 106; resp. 24; temp. 98°. Excited, talkative,
and abusive ; face flushed.

4th, p.m. — ^Pulse 100; resp. 24; temp. 98°. Is much better.
Paralysis continues, but tremor gone.

Case 5.— T. B— , male, set. 30. Admitted July 18th, 1867.
Tried in 1864, for housebreaking. Sentence seven years' penal ser-
vitude ; became insane during servitude.

August 8th, a.m. — In bed; pulse 64; resp. 36; temp. 99^°.
No abnormal chest signs ; paralysis of right facial ; pupils equal,
rather contracted; conjunctivae pale; brows knit. Says he feels
giddy when he gets up ; skin moist. Is very excitable, continually
shouting to a man whom he imagines to be at the top of the
building, p.m. — Pulse 64 ; resp. 32 ; temp. 99°.

9th, p.m. — Pulse 84; resp. 24; temp. 99°. Continues to be
excitable and noisy.

10th, p.m.— Pulse 80 ; resp. 16; temp. 99^°.

11th, p.m.— Pulse 62 ; resp. 20 ; temp. 99°. Continually noisy,
both by day and night.

12th, p.m. — Pulse 80 ; resp. 20 ; temp. 98-J-°. Has been quiet
during the whole of last night and to-day. Expression of face
much quieter.,

504 Falue of the Thermometer in Diseases of the [Jan.,

14th, p.m. — ^Pulse 60 ; resp. &0 ; temp. 9&f°. Is quieter, and
feels bett^.

Case 6. — J. R — , male, set. %%. Tried for arson at Salop
Assizes, July, 183&. Found insane. Admitted November, 1864?,
from Salop Asylum.

State on admission. — No abnormal chest signs ; is demented, and
can give venr little account of himself. Says he is fifteen years old,
and has only been six years in confinement. Occasionally wet at
night.

May, 1865. — Very demented; employs himself in dusting. Still
says that he is " fifteen years old."

November, 1866. — Has been very excited and talkative during
the last week. Is incoherent, and gives no rational answers to
questions; runs up and down, and rambles about the ward and
airing court.

August 10th, 1867. — In bed ; face fiushed ; both ears red, and
a little swollen; tongue white; bowels confined. Is continually
talking incoherently. Was very restless and noisy last night.
A.M. — Pulse 92; resp. &0 ; temp. 100°. p.m. — ^PuJse 84; resp.
20 ; temp. 100^°.

11th, a.m. — Puke 60; resp. 20; temp. 99^°; skin moist;
pupils equal, small ; brows knit. Complains of feeling cold ; con-
tinues talkative and noisy, p.m. — Pulse 64 ; resp. 16 ; temp. 99|°.

12th, p.m. — Pulse 64 ; resp. 16 ; temp. 99^ . Continues to be
talkative and noisy, both by day and night. Pupils equal, con-
tracted ; tongue white.

13th, p.m.— Pulse 60 ; resp. 20 ; temp. 99^°.

15th, p.m.— Pulse 80 ; resp. 20 ; temp. 994^°.

18th, p.m. — ^Pulse 58 ; resp. 16 ; temp. 99°. Is much quieter.

20th, p.m. — Pulse 60 ; resp. 16 ; temp. 98°. Is now much as
he was before the attack.

Case 7. — J. H — , male, set. 81. Admitted October 20th, 1864.
Tried at Leeds for murder, August, 1864. Found insane.

State on Admission. — Chest sounds normal. When questioned
about the crime, he sheds tears, and can hardly control himself;
says that he had not slept for a week before the commission of the
act ; that eighteen months since he was desponding and sleepless,
but that he recovered himself after a time.

March, 1865. — Is restless and excitable ; face flushed.

September. — Has been quiet and unexcitable for a considerable
period.

May, 1866. — Is again excitable and restless; says that he wakes
up at night with a feeling of dread, as if the world were coming to
an end. Complains of pain in the left frontal region.

1868.] Nervous System; by Dk. F, W. Gibson. 505

November 15. — Had been quiet since last report, until this
evening, when he rushed out of his room, took up a chair, and
broke seven panes of glass in the gallery.

February, 1867.- — Has been ^iiiet, and employed in garden since
last report. During the intervals he is perfectly rational ; has no
delusions. He always tells the medical officer when an attack is
coming on, and asks to be secluded, in order that he may do no
harm to any one.

March 21st. — ^In bed ; face flushed ; conjunctivae injected. Pulse
80 ; resp. 24 ; temp. 97f °. Says that he felt yesterday as if he
must commit some act of violence ; complains oi much pain in his
right frontal region ; did not sleep last night p.m. — Pulse 80 ;
resp. 20 ; teinp. 98"".

22nd, a.m. — ^Pulse 60 ; resp. 20 ; temp. 98°. Headache much
better, but he had no sleep last night.

April 8th. — ^Is now recovered.

August 25th. — Eemained well until to-day. This morning he
was seenjby me lying on a bench in the day-room in a sleepy, stupid
state ; face flushed ; complains of feeling ill, and says he wishes to
go to bed. P.M. — Pulse 64; resp. 16; temp. 99f°; face flushed;
sclerotic injection of both eyes, pupils equal ; no paralysis ; tongue
brown ; bowels confined.

26th, a.m. — Could not sleep last night. Says people visited him
and tormented him; head feels heavy. Pulse 48 (full) ; resp. 16;
temp. 99°. p.m. — Pulse 48; resp. 16; temp. 98f°; face still
flushed, and eyes injected; lies with eyes partly closed.

27th, a.m. — Pulse 48; resp. 16; temp. 98°; says he feels
mazed ; could not sleep last night.

28th, a.m. — Pulse 80 ; resp. 16 ; temp. 98° ; says he feels much
better ; manner more natural, and less excited, p.m. — Pulse 80 ;
resp. 16 ; temp. 98°.

29th, p.m. — Pulse 44; resp. 16; temp. 99°; does not feel so
well this evening ; face flushed ; brows knit.

80th, p.m. — ^Pulse 48 ; resp. 16 ; temp. 99f° ; is still restless
and unsettled.

September 1st. — Is now nearly recovered.

Case 8. — A. H — , set. 44. Admitted June, 1863. Tried at
Devizes, 1861, for larceny, and sentenced to eight months* impri-
sonment. Became insane during imprisonment. Sent to Devizes
Asylum in 1861. Is subject te attacks of recurrent mania.
During one of these attacks the following notes were taken.

April 18th, 1867, p.m.— Pulse 84; resp. 20; temp. 98°.
Tongue furred ; face flushed ; bowels confined. Is noisy, and talks
continually in an incoherent manner. The sentences she utters
appear to have a sort of rhythmical cadence.

506 Falue of tie TAermometer in Diseases of ike [Jan.,

August 15th, p.m. — ^Polse, 64 ; resp., 20 ; temp., 98°. Continues
mach as yesterday.

16th, p.nu— Pulse 60 ; resp. 24 ; temp. 98"^.

17th, p.m. — ^Pulse 60; resp. 2#; temp. 98°. Is now recovering.

Conclusums. — From the cases here given (and from others of
which I possess records, of which the temperature reached even a
higher degree, viz. 100° to 100^°), it appears that in some examples
of uncomplicated mania the tempersbne is above Hie norma] stan-
dard, though not considerably, and that in some other examples it
remains normal. Although the number of examples is not nearly
suiBcient to justify any definite conclusion as to the pathological
condition of the encephalon in each order of cases, yet the balance
of probabilities would appear to lean somewhat to the side of the
idea that there exists an overfulness of the capillary blood-vessels of
the membranes or of the cortical substance in the former class,
and not in the latter; and perhaps the thermometer may at some
future time serve as a guide in the diagnosis, prognosis, and treat-
ment of such cases.

In none of the cases did I find any notable depression of tem-
perature below the normal line.

Case 9.— C. C — , male, set. 40.

History. — Tried at Middlesex Sessions for larceny, after previous
conviction, in August, 1864. Sentenced to seven years' penal
servitude. Became insane during servitude. Admitted into Broad-
moor Asylum April 9th, 1866.

Stale on admission, — ^No abnormal signs in chest ; pupils, equal act
to light ; no strabismus ; ophthalmoscopic examination shows nothing
abnormal, save very slight cupping of the papilla in both eyes ; right
ear is " shrivelled ;'' tongue, protruded straight with difficulty, is
tremulous; speech very indistinct; muscles of lips and face tre-
mulous; there is no hemiplegia; face smooth; gait unsteady;
he walks with legs wide apart, and drags his toes ; he can button
and unbutton his waistcoat, and pick up small objects, but has
difficulty in directing the movements of his fingers ; swallows with
difficulty ; his food is minced for him. He is continually wet; last
night he passed a motion in his bed. There is no loss of sensation
in tips of fingers, palms of hands, or face.

Mental state. — Be sits in his chair, eyes half-closed, in a semi-
doze, with hands on knees. Gives no answer to questions, save
that when asked how he is, he says, "I am all right,'' and laughs.
Occasionally talks to himself, repeating the same phrase, '' The lag-
ging is done V

Feb. 14th, 1867. — Has remained much in the same state as on

1868.] Nervous Syatem; hy Dr. F. W. Gibson. 507

admission until last evening, when, whilst having a warm bath, he
became faint. He was ordered to bed at once.

His state on February 14th was as follow : — Pulse 96 ; resp. 24 ;
temp. 101°. Skin feels hot toihand; face flushed; pupils equal,
contocted, do not act ; twitches of muscles of face most marked on
right side ; no hemiplegia ,- twitches and tremulousness of muscles
of upper limbs. When uncovered he seems to be much distressed ;
tries to replace the clothes, and says, "The head say he must be
quiet." Passed his motions and urine under him in the night. He
recovered in a few days from this attack, but the pardysis was
increased somewhat afterwards.

August 8th. — Had another fainting fit to-day. Is now in bed, is
drowsy, and stupid; no convulsions. Pulse 64; resp. 20 ; temp. 98°.

12th, p.m. — Still remains in bed. Tongue white; skin dry;
pupils equal; no convulsions; is very heavy and stupid; face
flushed; no abnormal chest signs. Pulse 84 ; resp. 16 ; temp. 100^°.

18th, p.m— Pulse 100; resp. 16: temp. 101^°.

14th, p.m. — Pulse 100 ; resp. 16 ; temp. 102°-J^. Continues
much as on Aug. 12th.

15th. — Sleeps nearly all day; face flushed, p.m. — Pulse 80;
resp. 20 ; temp. lOOf. Sweating profusely.

18th, p.m. — Pulse 58 ; resp. 16 ; temp. 99°. Is much better,
and more lively. Asks what o'clock it is on seeing a watch, and
seems incb'ned to talk.

20th. — Is much as before the attack, p.m. — Pulse 60; resp.
16 ; temp. 98°. I quote this case of general paralysis mainly on
account of its being an example of the truth of the statements of
Ludwig Meyer, and of Dr. Saunders, that during the congestive
attacks to which such patients are subject when epileptiform fits
come on there is elevation of temperature. I have not found, how-
ever, as the latter physician's observations seem to have led him to
believe, that there is any abnormal depression of temperature in such
patients, at least not when care is taken to supply them with a suffi-
cient amount of food and warmth.

The phrase made use of by this man, " The head say he must
be quiet," expresses well the usual condition of this class of
patients. They dislike to be disturbed, cover themselves over when
the bedclothes have been turned back, cry out when they are being
washed, object to have their soiled garments removed. (These pecu-
liarities have not unfrequently been the cause of charges of cruelty
being unjustly brought against attendants and others.) They are
most happy and contented when left alone. There is no hyper-
sesthesia of the skin; at least I think not. They will, if allowed,
sit in front of the fire until the skin is actually scorched without
complaining.

508 [Jan.,

A few Observations on the Treatment of a Certain Class cf De-
structive Patients^ as pursued at the Colney Hatch Asylum.
By Thomas Beath Christie, M.D., Medical Superintendent of
the North Eiding Asylum, Clifton, York.

I QUITE feel with the Superintendent of Colney Hatch Asylum,
as he has said in his first paper, that a ^' dispassionate consideration
of a subject" is the best course to pursue when seeking after
" Truth/' Unhappily, stung and provoked by a reply, emanating
from a gentleman who, though only an " assistant*^ physician, ha8
evinced a fitness to attain a higher position, he has soon forgotten
the position he started to uphold, and has launched out into an
invective that is scarcely to be wished for in the pages of a Journal
that lays claim to a scientific character.

I certainly regret that our " principles," when fairly laid before
our professional brethren, are to be made the handle for a personal
attack ; and trust that, in now attempting to combat, in a slight
degree, the treatment as shadowed forth from the metropolis I may
not provoke anything beyond that earnest desire to collate facts
which may enable us to carry on our Christian calling in the
speciality we have chosen.

Far be it for me to stand forward as the exponent of a more en-
lightened system than appears even in " single dormitories, ranged
side by side, and lined with kamptulicon, linoleum, india-rubber, or
some other durable yet yielding substance, which constitute soft and
pleasant surroundings for a naked patient," &c. ; but, as a superin-
tendent of a large asylum, with an experience ranging over some
years, I feel reluctant to allow such " therapeutic" treatment to be
laid before the profession as the result of all our knowledge and ex-
perience. Surely we must have degenerated to the time when
Medicine was not deemed an art, but as belonging to the workers of
Magic, as I fail to detect in this proposed method of treatment any
nodus operandi for calming a noisy, destructive maniac, beyond
that which the revered Dr. ConoUy was so instrumental in de-
stroying.

The great argument for the kind of treatment proposed by Dr.
Sheppard appears to rest on the opinion that, in these cases of
destructive mania, the skin is hypersesthetic, and that therefore the
patient is intolerant of clothing. Now, is this really the case ? Is
the skin so much above the normal temperature as to warrant this
assertion? The tables adduced by Dr. S. W. D. WiUiams go far to
prove the contrary, and that in reality (excepting cases of organic
disease) there is no increase in the temperature. My experience

1868.] Observations on the Treatment of Destructive Patients, 50d

fully confirms this statement^ as several cases examined by Gassella^s
thermometer at this asylum have failed in showing any increase in
heat. Again, has not Dr. Sheppard ever observed that these very
destructive cases who are ^' so intolerant of clothing" during the
night will, with ease and comfort, bear their clothing during the
day; thus disproving in a most complete manner the untenable
position he occupies. Surely, then, if such is really the case, we
can find some other means of alleviating the sufferings of these un-
happy ones than that of letting " nature^' attempt to cure itself,
and the disease pass unheeded as beyond our reach.

I am convinced that these cases are often extremely difficult of
treatment, but yet fail to detect, even in the plan shadowed forth by
Dr. Sheppard, anything that would do more than degrade the high
calling of physician to the level of '^ asylum keeper," instead of, as
should be the case, to elevate us as the ministers of solace, comfort, and
restoration to the mentally alienated. I would, in condemning this
" do-nothing treatment," suggest that, in allowing the paroxysm of
destructiveness to expend itself, we are in most instances confirming
and tutoring these habits, till they veritably become ^' incurable."
When drugs have failed (which we must expect will sometimes be
the case), and all other means at our disposal have fallen helpless
before us, then, and then only, should we abandon the patient to
this passive restraint.

I have found, in many instances, that the cause of this destructive-
ness may be traced to neglect on the part of the attendant, added to a
want of proper action of the various secreting glands ; in exciting
the latter somewhat, and causing the former to pay more attention
to his duty, I have rarely failed, after a very short period, to modify
the habit, and thus lay the foundation of a further amelioration.
How many instances, too, have I seen where linen sheets have been
intolerable, while the blanket has acted as an excitant to the skin,
and thus prevented the desire to destroy ?

Speaking in general terms, the plan I would recommend in the
treatment of these cases, is to insist on a large amount of exercise in
the open air daily, combined with a free and generous diet, not being
too sparing in the administration of stimulauts, especiaUy brandy,
as that is by far the most sedative as well as stimulating of the
various alcoholic remedies, and full doses of Tinct. Opii. or Liq. Opii.
Sed. frequently. A comfortable bed is an essential which should be
supplied ; blankets, quilted on good strong canvas, being used as
coverings, as these cannot be easily torn ; and thus the excitement
produced by the first sound of tearing not being easily provoked,
sleep will overtake the patient before the gener^d destructive ten-
dency sets in. This practice, if persistently pursued, will be found
in the course of a few days to bring about the happy result aimed
at, though of course, as I have before stated, failure must occa-

510 . A Few Words in answer to Br, Edgar SAejoipard; [Jan.,

sionallj be looked for ; but disappointment need not be experienced,
as the practical physician knows that nature will often baffle his art,
and not unfrequently appear to hold him up to the ridicule of the
ignorant.

It must be understood that the above is not intended as the plan
of treatment I would pursue where tins destructiveness is a symptom
of " General Paresis/ as in these cases I would warn the physician
against the use of stimulants, as tending to aggravate rather than
ameliorate the symptoms, but to pursue the treatment by combioing
lialf a drachm of Tinct. Digitalis with ten minims of Tinct, Opii.
three times daily in the place of the brandy.

Without in the slightest degree casting censure on the Medical
Superintendent of Cohiey Hatch, who complains of the *' sensation^'
articles in the newspapers, may not the cause for them be traced to
the large number of patients placed under his care, and the conse-
quent prevention of his paying that thought and attention which are
demanded in these difficult cases. No one, I am sure^ would wish
to stigmatise his treatment as " cruel,^' but I think he must admit
that there are other plans more rational, and certainly more "humane,''
than the placing a patient for a night in a padded room unheeded till
the morning.

I trust, although very brief, I have said enough to convince the
unbiassed that, after all, there need not be any fear of retrogression,
but that the enlightened treatment of the insane, as instituted by
Pinel, will go on progressing, till this most distressing of all
diseases will be treated with that sympathy and watchfulness which
its nature demands.

A Few Words in Answer to Dr. Edgar SAeppard, By S. W. D.

Williams, M.D., &c. &c.

I AM very loth again to take up the time of the readers of this
Journal on the subject of the " treatment of a certain class of de-
structive patients," but Dr. Sheppard, in the last number,* has in
many places so misunderstood my meaning, and consequently so
misrepresented my facts, that I cannot allow his paper to pass
without endeavouring briefly to rectify some of the more glaring
discrepancies.

* ** Some further Observations in reply to Certain Strictures upon tlie Treat-
ment of a certain class of Destructive Patients/' By Edgar Sheppard, M.D.,
Medical Superintendent of the Male Department of Colney Hatch,

1868.] ' hy De. S. W. D. Williams. 511

The points I would thus call attention to are : —

I. Bt^ She^pard's assertion Hat I was specially reqiiested by the
Editors of the ^Journal of Mental Science^ to write my
article in the July number,
H. His complaint of my inaccuracy — whether it is correct,
m. His misrepresentation of certain points in the treatment I
advocate.

IV. His remarks on the too energetic use of certain pmoerful

medicines in insanity.

V. His earperiments and conclusions on temperature in destructive

and maniacal patients,

VI. His attempt to prove that my physiology is opposed to that held

by Br, Brovm-SSguard,

VII. His complaint that an assistant medical officer should have

written calling in question his views,

VIII. Farious extracts from foreign scientific journals, showing the
injury Br, 8heppar£ s paper has already done,

I. Within the first two pages of his article^ Dr. Sheppard twice
refers to myself as an advocate especially retained by the Editors of
the ' Journal of Mental Science' to publish a system of treatment
contrary to, and therefore condemnatory of, the novel one he has
himself propounded; and in one passage he sneeringly puts in
antithesis two sentences of mine, without the least reference to the
context, and which consequently appear to contradict one another.
He writes — ^^ Invited by me in general terms to a dispassionate
consideration of an important subject, he puts himself individually
forwards, at Hhe request of the Editors of this Journal,' to propound
a system of which, nevertheless, he adds, he is not ' the authorised
exponent.' " By so writing, Dr. Sheppard has entirely perverted
my meaning, and lays himself open to the charge of inaccuracy
which he has so indignantly urged against myself. I must deny,
and indeed never attempted to mate it appear, that I was specially
requested by the Editors of this Journal to write my paper, and, as
must appear to all in reading it, in stating that I wrote ^' at the
request of the Editors of this Journal," I simply referred to their
foot note to the article Dr. Sheppard wrote in the number for last
April, in which they '^ ask from some members of the association
the results of their experience in the treatment of the troublesome
class of patients referred to in Dr. Sheppard's paper." This may
appear, and is in truth but a trifling matter ; nevertheless it at least
illustrates the inaccuracy I complain of.

II. Dr. Sheppard considers he has " a right to complain" of my
^* inaccuracy," because I base my disapproval of his treatment on
the method as it was really carried out by his orders at Colney

512 A Few Words in answer to Dr. Edgar Shy)pard; [Jan.,

Hatch^ and not on a hypothetical ex post facto system of treatment
which he expounded after the Commissioners in Lunacy had had
their attention drawn to the real treatment adopted^ and with which
he cleverly attempts to draw off attention from the question at issue.
Well, let us humour Dr. Sheppard for once ; he complains of my
picture of the four bare walls and the wooden floor as oeing unfor-
tunate for the patients entrusted to his care, although the fact is
yet much too matter of fact, and with all a poet^s licence he paints
a glowing picture of " soft surroundings/' and '' unirritating
wrappings/* and of '^ a few single dormitories ranged side by side,
and lined with kamptulicon, linoleum, india-rubber, or some other
durable yet yielding substance/' which "would constitute soft and
pleasant surroundings for a naked patient.'' Truly may we exclaim,
m the words of Cicero : — " Nihil tam incredible est, quod non dicendo
fiat probabile; nihil tam horridum, tam incultum, quod non splendescat
oratione, et tan(juam excolatur." But does Dr. Sheppard really
believe in all this, or is he only laughing at our beards. Let us
recal his sensational and startling picture of the destructive patients
he would place in these delightful rooms. He writes — " The worst
subjects . . . will destroy padded rooms, sheets and blankets and
strong rugs they rip to shreds, and have only their full measure of
satisfaction when they have reduced themselves to a state of complete
nudity," &c. &c. -Ajid these are the people we are told to put naked
in rooms " lined with kamptulicon, linoleum, india-rubber, or some
other durable yet yielding substance." Does Dr. Sheppard mean,
in sober earnest, to affirm that the patients just described, who tear
down padded rooms, &c., with so marvellous a facility, would respect
such tempting substances as kamptulicon or india-rubber ? I trow
not ; and I ask any one conversant with the ways and habits of the
insane whether, if a destructive patient were placed naked in such
a room, he would not immediately begin to work with his nails and
teeth on the " durable yet yielding substance/' until he had worked
a hole, when the total destruction of the " soft surrounding" would
very quiekly follow ?

If I remember correctly, it was on the score of expense that the
four bare walls and the wooden floor system was first inaugurated.
I fancy that the destruction of such expensively-fitted dormitories
as the above, would cover in the way of expense the tearing up of
very many sheets and rugs.

III. Another point I complain of is the manner in which my
clinical record of treatment has been misrepresented.

In my report of the case of H. F — , appears the following
sentence : — "At one time irtx doses of dilute hydrocyanic acid were
given hina every fifteen minutes daily (!) until the pulse was affected,
but all with no benefit, ^^ (The note of admiration and the italics are

1868.] hy Dr. S. W. D. Williams. 513

Dr. Sheppard's.) I am willing to allow that this sentence may, at
first sight, appear a little involved, but I think I have a right to
complam at its being so distorted as it is by Dr. Sheppard's addi-
tions. " Nihil est quin male narrando possit deprivari.^^ He
evidently wishes to make it appear that this poor man had iti.x of
dilute hydrocyanic acid every fifteen minutes throughout each day,
and he totally ignores my limit '^ until the pulse is affected.^' Now,
he must know that if such a course had been pursued, the patient
would, long ere this, have been a fit subject for a coroner's inquiry.
All who have thus prescribed hydrocyanic acid must be aware that
four, or at the most, six doses at such intervals would have had the
desired effect (^^ the influence on the pulse'^).

It may be remembered by the readers of this Journal that the
hydrocyanic acid treatment was first brought to the notice of the
profession by Dr. Kenneth McLeod, in some admirable papers
published by him in the ^ Medical Times and Gazette/ about four
years ago, and reprinted in this Journal.

Criticising the same case. Dr. Sheppard talks of this ^^ un-
happy martyr, H. F — ^^ of the "great risks'^ he was subjected
to by such "heroic treatment/^ and of the wonder he lived
through it, and finally he is pleased to make merry at my ex-
pense. '^ Nature,'^ writes Dr. Sheppard, ^^is wonderftdly kind and
restorative to some of us, and baffles the well-meant but mistaken
energies of the most enthusiastic physician, while he is playfully and
illogically regarding her triumphs as the result of his skilful art.''
But let those laugh that win. This man is now as sane as ever he
was in his life. When he was admitted into this asylum he weighed
9st. lOlbs. ; when the medicine was omitted, twelve months after-
wards, he weighed 13st. lO^lbs. This does not look as though he
had been brought through any very severe ordeal in the interim.
Moreover, these desirable results were brought about without its
being considered necessary to turn him into an empty room, without
bedding or clothing.

IV. ''There is something within,'' writes Dr. Sheppard, '' which
tells me that nothing can justify the pushing of an heroic remedy to
such an extreme as is advocated in the last number of our Journal,"
for *' there is no remedy that produces a more deadly faintness and
indescribable prostration than digitaUs." There is something within
which tells nle that if I prescribed medicines with so little judg-
ment and care as to constantly produce " such deadly faintness and
indescribable prostration," I would, to say the least, be very loth to
publish my incapacity to the world. But although this effect of digi-
talis is all very true, if the digitalis be given in sufficiently large and
powerful doses, yet the whole gist of my argument went to prove that, if
given in mania judiciously and in carefully-regulated doses, and

514 A Few Words in answer to Dr. Edgar Sheppard ; [Jan.,

always providing that there is a skilled person at hand with time
and opportunity to watch its effects, it produces the very opposite
results, and the patient becomes calm and grows fat on it^ as 1 have
already shown in the case of H. F.

Furthermore, my experience differs very materially from Dr.
Sheppard's in many of his descriptions of cases. Thus, he says,
general paralytics prefer nudity. I have always found them
peculiarly sensitive to cold; they huddle themselves up together,
crowd round the fires, and at night, when sleeping, almost invariably
cover their heads over with the dothing. When they are destructive,
is it not due rather to the laboured promptings of their diseased
brains than to any special desire for nudity? Often when they have
amused themselves by tearing up everything, they place the chamber
utensil on their heads, and employ the weary hours of their solitude
in tying and twisting the shreds of their clothing all around their
persons. And as to a patient ^' alluding in terms of gratitude to
nis permitted nudity,'' who, I ask, can seriously fancy the dreadful
cases referred to by Dr. Sheppard having sufficient command over
their ideas to make any such speech.

Dr. Sheppard says that Dr. Davey, who has practised our
specialty in a tropical climate, has '^ seen the naked negro panting at
the line," whatever that may mean, "and would as soon have thought
of wrapping up a destructive lunatic in cobwebs as of fettering him
with any sort of clothing.'' I totally fail to perceive in what way
this can bear on our subject. Because in a tropical climate a mad
negro is allowed to go naked, that being, it must be remembered
also, his natural condition when sane, therefore, in our temperate
zone and variable climate, a destructive patient, who when sane
was accustomed to the clothing civilisation dictates, is also to go
naked I Dr. Sheppard accuses me of being illogical, but I might,
if disposed, retort on him as being more illogical stiU.

But what is the end, what is the conclusion at which Dr.
Sheppard wishes us to arrive, after a careful perusal of his paper ?
It appears to me that there is but one conclusion, and all his argu-
ments would tend to point to it. It is that we must surrender our
hiffh and honourable office of healing insanity, of ministering medi-
cally to the mind diseased, and descend simply to superintending it.
The title of medical superintendent will become a misnomer, and
must for the future be given up; the prefix medical must be
dropped, and the word superintendent or governor adopted. "Hie
actions of medicines are uncertain and imperfectly understood;
they are liable to abuse, therefore they must be abandonned. The
vis medicatrix natura, which seems to be to the new school of
psychiatric their sole pharmacopoeia and the god of their idolatry,
is to be the only allowable therapeutic agent, although the vivid
imaginations of this new school of prophets have not as yet been

1868.] by De. S. W. D. Williams. 515

able to propound what this remedy is to effect in the deadly disease
of general paralysis. Dr. Sheppard declares that he is not alone in
his views, and that they are shared by others of our associates. But
when skilful physicians, men learned and experienced, thus declare
their incapacity to grapple with their enemy, surely this is an argu-
ment in favour of increased labour and experimentation, rather
than for quietly folding our hands before us and blindly trusting to
Providence.

V. Dr. Sheppard's conclusions on temperature in insanity are
founded on so admittedly limited an experience that they scarcely
require refutation. He examines four healthy men on three different
occasions, and from these few observations fixes the normal tempera-
ture of the healthy human body at 96^*7. I, however, with all due
deference, prefer still to adhere to the standard as fixed by Dr.
Aitken, in his work on 'The Science and Practice of Medicine,'
viz., 98°*4. And as Dr. Sheppard owns himself that the average
temperature of four destructive and maniacal patients whom he
examined thermometrically, was 98°* 3, which is but very slightly
above what I set it in my paper, I still adhere to my statement that
there is no appreciable elevation of temperature beyond the normal
standard in such patients.

TI. At the end of his paper. Dr. Sheppard has endeavoured to
hold me up to ridicule, as attempting to propound an opinion on a
physiological point opposed to Dr. Brown-Sequard^s expressed views.
That '^ ansBsthesia is accompanied by a diminution of temperature,
and hypersBsthesia by an increase,'^ are truisms I never attempted to
disprove; and I am at a loss to imagine in what portion of my
paper Dr. Sheppard finds I endeavoured to do so.

Vn. The whole tone of the paper under consideration renders it
so evident that those who run may read, that great soreness is felt
by its author that an assistant medical officer should have had the
temerity to call in question the "well-matured statements and
avowed belief" of a metropolitan medical superintendent. But I
would ask, who acts in the most "unmeasured and immodest
manner,^* the medical man who objects to the treatment of another
medical man, with whom he is totally unconnected, and expresses
his reason for so doing, or the medical superintendent who, in the
face of the recorded opinion of the visiting justices, whoBe servant
he is, and of the Commissioners in Lunacy, to say nothing of
nearly the whole medical press, persists in parading and defending,
before the eyes of the public, a plan of treatment which has been
ahnost unanimously condemned, and which he has been forbidden to
practice in his asylum, on the ground of its being "inconsistent with
modem civilisation, and unwarrantable in this philanthropic age ?^'

516 A Few Words in answer to Dr. Edgar SAeppard; [Jan.^

I should be the last to defend an assistant medical officer who
attacked his own immediate superior ; bat that no assistant medical
officer is to express views opposed to those held by any medical
superintendent, is a postulate no unbiassed person can hold, and
besides is eminently detrimental to the progress of science.

It would not be considered " unmeasured and immodest'^ for an
assistant physician of one of the London hospitals to express
diflferent views from those already published by the senior physician
to another hospital ; and why Dr. Sheppard should make such a

f'evance of my publishing a plan of treatment opposed to his own
cannot understand, especially as I am careful not to vaunt the
system as my own, but as the plan I have seen adopted at the Sussex
Asylum — although, if it came to a matter of experience between
us, I think I may consider mine as the greater, as, even officially, I
have been connected with asylums longer than Dr. Sheppard, and
can, moreover, lay claim to naving superintended the whole of a
large asylum for more than twelve months, an experience more
varied and instructive than the medical charge of one side of an
overgrown metropohtan asylum, and that, moreover, the male depart-
ment, which is always the least troublesome side of an institution for
the insane.

Vill. In my paper already referred to I stated that one of my
reasons for writing it was a great unwillingness that Dr. Sheppard
should " offer himself unchallenged as the exponent, before our Con-
tinental brethren, of the practice of the English non-restraint
system,'^ being fearful of the handle they would make of his paper
to attack it. This fear, as the following extracts will show, has,
I am sorry to say, been fulfilled.

From tie 'Archiv fur Psychiatrie und Nervenhrankheiten! Edited
by Br, W. GrieAngery Br. L. Meyer y and Br. C. Westphal.

"An Excrescence on the Non-restraint System. — ^In the April
number of the 'Journal of Mental Science' for this year. Dr.
Sheppard, the medical superintendent of the male department of
Colney Hatch, has published a pjqper in which he enunciates original
views on the treatment of a certain class of excited patients who
constantly undress themselves or tear their clothing and bedding.
He bases these on the theory that the skin of those patients is hyper-
sesthetic, and the temperature abnormally high, that hence the
clothes are an annoyance, and that we are wrong in preventing those

J)atients from undressing themselves. Acting on this theory he
eaves them naked, locked up in padded rooms, and he is evidently

1868^ iyiiR. S. W. D. Wilijams. 617

of opinion that physicians and patients^ as well as the property of
the asylum^ are thus alike best considered.

' *'In consequence of information given by an attendant. Dr.
8heppard had his treatment called in question by the commissioners
and the committee of visitors. His practice was entirely condemned,
and the committee of visitors gave him positive instructions in
accordance therewith.

"In the beginning of July I visited Colney Hatch, and was
accompanied round the asylum by Dr. Sheppard^s assistant, he, un-
fortunately being engaged. Despite the instructions of the com-
mittee I saw several maniacal patients, some stark naked, shut in
the padded room, others — these being quiet general paralytics — >
lying under a coverlid without a shirt. The assistant-physician
accompanying me neither found fault with the attendants, nor gave
instructions that the patients should be clothed, as I thought the
position of sSaits required; on the contrary, he appeared to view the
occurrence as in the natural course of events. My companion,
indeed, willingly listened to my remarks, but I did not succeed in
convincing him of the error of such treatment, imbued as he
evidently was with the Sheppardic theories. How, then, does it
happen, I must ask, that an asylum physician like Dr. Sheppard,
who admittedly devotes himself with the greatest zeal to the care of
his patients, and whose honourable character is acknowledged by all,
'should have arrived at such a delusive theory? The explanation
lies simply in CJolney Hatch itself. An asylum with more than 2000
patients and only two directing physicians, one for the male, the
oth^ for the female department, each with only one assistant physi-
cian, and, excluding head attendant, one attendant for twelve
patients is indeed an impossibility, and impracticable with or
without restraint.

"In either case, neglect of the patients must follow such a
colossal numerical concentration. In practice he who can read the
pign sees clearly, as regards the patients, this failure written up
on the whole asylum. Yet it must result that the opponents of the
non-restraint system will quote Dr, Sheppard' s practice in support of
restraint. See, they will say, whither this lauded non-restraint
system leads us. Instead of methodically restraining the patient, it
prefers to leave him naked, knocking himself about in his cell.
Against such arguments I would desire boldly to defend the sup^
porters of the non-restraint system.

" Non-restraint, understanding by the term not merely the disuse
of the straight-jacket, but rather in the spirit of Conolly^s teaching,
the constant and unwearied care for the patient, so that all appeal to
force ig avoided, such realisation of the non-restraint system is not
known in Colney Hatch, and cannot be so, so long as the numerical
relations I have above referred to remain, except indeed under the

XIII. 36

618 A Few Words in an9wer to Br. Edga^ Sheppard; [Jan.,

rarest accident and through the exertions of some singularij gifted
physician. Practice such as I have referred to is not an argument
against the non*restraint system^ but only againat asylums of the
enormous size of Cokey Hatch, which inde^ resembles anything
rather than a hospital.

^'Dr. Sheppara has further had the unhappy inspiration to defend
his practice on scientific and theoretical grounds* I notay, however,
spare myself the trouble of refuting his arguments, inasmuch as
tney have with one voice been rejected in England, where ih&j have
received a spirited exposure by Dr. Williams (' Journal of Moital
Science,' Julv, 1867).

" It would, moreover, appear that Dr. Sheppard has only had a
limited experience in the treatment of the insane, in which he has
been entirely self-taught. If I am not wrongly informed, he was
appointed to his important charge at Colney Hatch before he had an
opportunity of becoming practically acquainted with the treatm^t
of mental disease.

" I would not have mentioned Dr. Sheppard's name in this notice
— knowing him to be one of the most esteemed superintendents in
England — ^were it not that in Germany many intentional, as wdl as
unintentional, misrepresentations of the form of treatment with
which his name is connected wiU occur.

" I would guard against the opinion being held of any question
herein depending of the inefficiency, or indeed injurious infiuaice of
the non-restraint system, and still more of such things being
common events in the English asylums. So far from these practices
witnessing against the non-restraiut system, they merely show in
what that system does not consist, and the merit of the many
English asvlums in which that system truly and in spirit is
adopted, only stands out the brighter by the contrast." — I Heft. 1868,

This notice bears the initial of Dr. C. Westphal, Privat-Docenten
an der Universitat Berlin, one of Professor Qriesinger's co-^editors.*

* Since the above translation went to press, the fblk>wing annotatioB appeared
in the ' British Medical Journal ;' a paper which is always in advance i^. infonoft*
tion concerning insanity.

''THB TBBATMBNT OF LTTyATIOS AT OOLKEY HATCH ASTLTTM,

" The foUowing statement occurs in the first number of Professor Griesinger's
new and ezceUent journal, ' Archiv for Psychiatrie und NervenkranJcfaeiten.' It
is signed * W.*

. « t -y^gQ \ Yigxted Colney Hatch early in July last, X was conducted through th^
asylum by Dr. Sheppard's asnstant, he himself being unfortunately prevented from
accompanying me. Notwithstanding the instructions of the committee, I saw
several patients, some of whom (maniacal) were shut up in cells pm-feotly naked,
while others (quiet paralytics) lay in bed without shirts. The gentleman who ac«
companied me neither blamed the attendant nor gave any directions for clothing
the patients : the practice seemed to be the usual one. He readily entered into
my arguments against it, but evidently shared Dr. Sh^pard'B views; a|id I did
not succeed in convincing him by the discussion of the improprietiy of fuch a pro-
cedure. . . . The adversaries of nou-rcstraint will not fall to claiin the ca3e of
Pr. Sheppard in the interest of restnunt. ' See,' It wiU be s«d,^ vfaat your hearted

1868.] hy Da. S. W. D. Williams. 519

Prom the ' Fierteljahrs9ohryi fiir Psychiatrie,' heram^egeian v(m
Prcfe^or Dr, Max Leicksdorfy und Boceni Dr. Theodor Meynert^

In the first number of the New Vienna Quarterly Journal on
Psychiatrie, edited by Professor Leidesdorf, an analysis is given of
Dr. Sheppard's original paper, and to this Dr. Leidesdorf appends
the following observations : —

*'The Editors of the ^Journal of Mental Science/^' he writes,
'^ add in a note that they cannot accept Dr. Sheppard's views, and
they ask illustrations from their confreres as to how such cases of
destructive mania are best dealt with. At any rate it appears to us,
from a consideration of this paper, that the English non-restraint
system, of which Dr. Sheppard asserts himself to be a strenuous
supporter, strangely contradicts itself when brought to the test iu
jbhese trying cases.'^ — I HefU 1867.

From the ^American Journal of Insanity ^ for July, 1867.

" This affair has called forth a letter from Dr. Edgar Sheppard,
medical superintendent of the male department of the Colney Hatch
Asylum, in which he comments with great force and justice upon
the reckless greed of newspaper conductors for sensational stories,
without regard to consequences, and upon the extravagant expecta-
tions of the public in regard to the care of the insane. He says,
truly, that there are patients whom no possible means can prevent
from denuding themselves, from destroying their clothing, and
smearing their persons with their own filth. It seems to us, too,
that his explanations fully meet the charges of neglect and abuse
made against his institution. The letter contains, however, certain
theories in regard to the destructive propensity in mental disease which
we cannot fully accept. They do not lack plausibility, and are set
forth with much skill, but give us, notwithstanding, the impression
of having been framed to meet the practical difficulties of the
doctrine of non-restraint. How, then, are patients, who will
destroy padded rooms and tear the strongest rugs and blankets into
jghreds, to be managed ? There is no other way, in the disuse of
riestrauit, but that of turning them naked into rooms bare of every-
thing that can serve for clothing or protection. Such an alternative,
the Commissioners say, ' is unheard of in this philanthropic age, and

non-restraint leads to ! Instead of properly restridning the patient, you prefer
letting him rave naked in his cell !'

" The writer goes on to point out that his experience at Colney Hatch was quite
exceptional, and attributes what he saw there to the impossibility of properly
managing so vast an asylum with its present staff of medical officers^ Neverthe-
less, be heads his paper, ' The Fruits of Non-restriuut.' " — British Medical Journal,
November 30.

520 A Few Wards in answer to Dr. Edgar Shejtpa/rd. X^^*^

9ach circumstances admit of no sort of justification/ We do not
wonder that Dr. Sheppard feels compelled to find some other plea for
refusing to employ sufficient restraint in such cases than that it
would * rob the patients of their pleasurable sensations/

"As we have said. Dr. Shepparas arguments are not a little inge-
nious, and we may now and then find a case like the one described
by the writer which may be cited in their support. But it seems to
us impossible, for one who has had any considerable experience of
acute mania, to suppose that the propensiiy to destroy clothing has
more to do with the temperature or sensibility of the skin than that
to destroy windows or to overturn whatever comes in the way.
Maniacal fury is connected with delusions just as various as the cases
in which it occurs, and the nature of these delusions has no constant
relation to anything in the mental experience or the external circum-
Btances of the patient, so far as has yet been ascertained.

^^Of the paretic class of destructive patients, he says that 'th6
expiring energies of life seem to be concentrated upon ripping and
tearing everything that comes within reach/ That is^ the tendency
to destroy is general, as we stated it to be, usually, in mania: This
agrees with our experience of this class, and we see nothing in this
destructiveness to prove that ' the soft and unirritating wrappings of
the atmosphere^ are indicated as the appropriate clothmg.

'^ Dr. Sheppard also finds confirmation of his views in the fact that
' in some cases of general paralysis this dermal hypersesthesia and
elevation of temperature are not continuous, but liable to fluctua-
tion ; the destructive mania then commonly fluctuates with it,' We
cannot think it very remarkable that the dermal sensations should
be heightened in the siame ratio as the cerebral excitement, or that a
maniacal paroxysm should be accompanied with increased heat of
skin.

" But it is hardly necessary to pursue this subject. No one caA
perceive more clearly than we do the evils which flow from the use
of restraint in the treatment of the insane, and all who endeavour
to control those evils have our hearty sympathy. Use, however, is
hot necessarily abuse, and those who can see no other way of pre-
venting the latter thwi by advocating the entire abolition of restraint,
must expect to meet with numerous practical and logical diffictdties/'
" — American Journal of Insanity, July, 1867.

J868.] 621

On Aphasia or Loss of Speech in Cerebral Disease. By Frederic
Bateman, M.D., M.K.C.P., Physician to the Norfolk and
Norwich Hospital.

Aphasia is the term which has recently been given to the loss of
the faculty of articulate language, the organs of phonation and of
articulation, as well as the intelligence being unimpaired. The
pathology of this affection is at the present time the subject of much
discussion in the scientific world; the French Academy devoted
several of their seances during the year 1865 to its special elucida-
tion, and the Medical Journals of France and of our own country
have lately contained a good deal of original matter bearing upon
this obscure feature in cerebral pathology.

In a short paper published in the ' Lancet^ for May 20, 1865, I
jdrew attention to the existing state of our knowledge of the
pathology of aphasia; since that period I have had occasion to
make researches among various British and foreign authors, and
having noticed a certain number of curious observations bearing
upon this interesting subject, I have thought it not a useless task in
this short essay to give a resume of the labours of scientific ob-
servers in various parts of the world, who are endeavouring to
•elucidate this complex question, adding thereunto the result of my
own personal experience, the clinical history of my own cases being
given with a considerable amount of detail.

From time immemorial loss of speech, unconnected with any
other paralytic symptom, must have been noticed ; but it is only
of late that the diagnostic value of this symptom has been recog-
nised, and its pathology attempted to be explained; and it is
probable that early observers may have confounded paralysis of the
longue from disease of the hypoglossus, with that loss of the
memory of words, and inability to give expression to the thoughts
which characterise aphasia.

It has been stated that Hippocrates confounded aphasia with
aphonia; I am inclined, however, to think that the reputation of the
Father of Medicine has suffered from the fault of his English trans-
lator, for in his ' Epidemics' he describes a disease characterised by
sore throat and hoarseness of voice, using the phrase ^'ttoXXoI
^apvyya^ iirovricrav (j^wval KaKovfiivai/' the last two words of which
have been erroneously rendered in English " loss of speech !'* In
another place Hippocrates clearly distinguishes between loss of
speech and loss of voice, by employing the words ^' ^vavSog" and
" aittjvog" in the description of the same case.

The following passage from Sauvages shows that the distinction
was clearly understood by him ; " Aphonia est plenaria vocis sup*

522 Aphasia, or Loss of Speed in Cerebral Disease; [Jafi.>

pressio. Mutitas (quibusdam alalia) est impotentia voces articolatas
edendi, aeu sermonem profereadi/^

As this subject has more particularly engaged the attention of
French pathologists during the last few years, it is most eonveuient
to consider first their researches.

The minute anatomy of the surface of the brain not being to my
knowledge described in any English author with the same amount of
detail as occurs in M. Broca's description^ I have condensed tk
following account from his work, " 8ur le Si%e de la Eacult^ du
Langage Articul^/'

The anterior lobe of the brain comprises all that pai^ of tbe
hemisphere situated above the fissure of Sylvius (which separates it
from the temporo-sphenoidal lobe), and in front of the furroif of
Eolando, which divides it from the parietal lobe. The furrow of
Bolando separates the frontal from the parietal lobe; it traverses
from above downwards all the external surface of the cerebira] hemi'-
sphere, starting from the inter-hemispheric median fissure, mA
ending at the fissure of Sylvius ; in front this furrow is bounded
by the transverse frontal convolution, and behind by the toinsv^^se
parietal convolution. The anterior lobe is composed of two ^rys
t)r divisions, one inferior or orbital, the other superior, situated
beneath the frontal and under the most anterior part of the parietal.
Hiis superior division of the anterior lobe is composed of four
fundamental convolutions, one posterior, the others anterior. The
posterior is that which has been described as the transverse frontal,
and which forms the anterior border of the furrow of Bolando; the
three other convolutions have all an antero-poeterior direction, and
lure distinguished by the names of superior ot first frontal, middle or
second, and i^erior or third, frontal convolutions. This last by its
posterior half forms the superior border of the fissure (rf Sylvias, the
mferior border being formed by the superior convoluticm of the tern*-
poro-sphenoidal lobe. In drawing asunder these two convolutions
which bound the fissure of Sylvius the lobe of the insula is exposed,
which covers the extraventncular nucleus of the corpus striatum.
The result of these relations is that a lesion which is propi^ted
from the frontal to the t^nporo-sphenoidal lobe, or vice versd, will
pass almost necessarily by the lobe of the insula, and from thence,
in all probabihty, it will extend to the extxav^itricular nucleus (rf
the corpus striatum, seeing that the proper substance of the insuk
which separates the nucleus from the surface (rf the bram is com-
posed of only a very thin layer.

As far back as 1825 BouiUand placed the faculty of articulation
in the frontal lobes of the brain, which he considered to be the
organs of the formation of words and of memory; and he stated
that the exercise of thought demanded the integrity <i these lobes;

1868.] %r Dk. Fbedbrio BaI'esian. ' 623

lie abo ooUeoted 114 obsenrations of disease of the anterior lobes
acoompnied by lesion cf the factdty 6f speech.

AocHral, who has investigated the subject very fully, analysed 37
cBSes> obs«*ved by himself and others^ of lesion of one or both of
the anterior lobes, and found that speech was abolished 21 times,
find retained 16 times ; when the lesion was unilateral, however, he
lias not stated on which side the morbid condition existed. He has
also collected 14 oases where speech was abolished without any
alteration in the anterior lobes, but where the lesion existed in the
Boct^ or in the posterior lobes. He cites the case of a woman,
eighty years of age, who, three years before entering the hospital,
was suddenly deprived of speech, without lesion of the intelligence,
motion, or sensation, and retaining the power of walking about ; she
p:«esented, however, signs of organic disease of the heart, and died
at last of pulmonary apoplexy. At the necropsy there was found
in the left; hemisphere softening of cerebral substance on a level
with, and external to, the posterior extremity of the corpus striatum ;
and in the right hemisphere, a similar softening at the junction of
the anterior and posterior half of ike hemisphere.*

Then comes Dr. Dax, who places the lesion exclusively in the left
hemisphere ; basing his theory on the fact that when the subjects of
aphasia are at the same time hemiplegic, the paralysis is always on
the riffit side, his essay containing no less than 140 observations in
support of his views.

His son. Dr. G. Dax, following in the wake of his father, wrote
an essay, in which, whilst confirming the theory as to the lesion
being in the left hemisphere, he localised it more especially in the
anterior and external part of the middle lobe.

The na plus ultra of pathological topography, however, was
reserved to M. Broca, who defines the seat of lesion in aphasia to be
*' ^ posterior part of the third frontal convohition of the left hemu
sphere i^' M. Broca^s views are detailed at some length in the
proceedings of the Paris Anatomical Society for 1861, and the
following is a brief summary of the two cases upon which he has
founded his somewhat startling theory.

A man named Leboi^ne, 60 years of age, and epileptic, was ad-
nutted into the sui^ical ward of M. Broca, at Bicetre, for phleg-
monous erysipelas, occupying the whole of the right lower Umb.
When M. Broca questioned him about the origin of his disorder, he
only answered by the monosyllable '^Tan,'^ repeated twice, and
accompanied by a gesture of the left hand. On making inquiries, it
transpired that this man had been an inmate of the hospital in another
wing for twenty-one years ; that he had been the subject of epilepsy
sinee infancy ; that he had followed the occupation of a lastmaker

* * Clinique H6dical«/ chap, jv, ojiwerT. xvii . . -

624 Jpkana, pr Loh of Speech in CerehrU Disease ; ' [Janl^

up to the age of thirty, when he lost his speech, but no inforniation
could be elicited as to whether the loss of speech had come on snddmily,
or had been ushered in by any other symptom. On his admission at
Bic^tre he is stated to have been intelligent, understanding all that
was said to him, and differing from a perfectly healthy man only in
the loss of the faculty of articulate language, for whatever question was
put to him, he invariably answered by the monosyllable "Tan/' which»
with the exception of a coarse oath (" & — «— de B — ^'), composed
his vocabulary. At the end of ten years, a new symptom showed itself
in weakness in the motor power of the right arm, which gradually
resulted in complete paralysis of the right side, and he had abeady
been bedridden seven years when the occurrence of a surgical com-
plication rendered it necessary to transfer him to the ward of M.
Broca, who, in describing his then condition, states that there was
no distortion of face, the tongue was protruded straight, the moye«>
ments of that organ being perfectly free in every direction ; mastic-
cation was unimpaired, but deglutition was ^ected with some
difiSculty, this being however due to commencing paralysiis of the
pharynx, and not to paralysis of the tongue, for it was only thfe
third period of deglutition which was difficult; the voice was natural,
and the functions of the bladder and rectum unimpaired. : The patient
having died in six days, a careful post-mortem examination was made,
when all the viscera were found healthy, with the exception of the
encephalon ; the muscles of the right upper and lower extremities
however, were in an advanced stage of fatty degeneration and shrivdled
up. The bones of the cranium were somewhat increased in density, the
dura mater thickened and very vascular, the pia mater considerably
injected in certain places, and everywhere thickened, opaque, and infil*
trated with yellowish plastic matter of the colour of pus, but which,
examined under the microscope, did not contain any pus-globules. The
greater part of the frontal lobe of the left hemisphere was softened;
and the destruction of cerebral substance had resulted in a cavity of
the size of a hen's egg and filled with serum; the cavity was
situated upon a level with the fissure of Sylvius, and was caused by
the destruction of the inferior marginal convolution of the temporo-
sphenoidal lobe, the convolutions of the island of Eeil, ana the
subjacent part or extraventricular nucleus of the corpus striatum.
In the frontal lobe the inferior part of the frontal transverse convih
lution was destroyed, as also the posterior half of the second and
third frontal convolutions, the loss of substance being most apparent
however in the third frontal convolution. The weight of the
encephalon after the evacuation of the fluid filling the cavity did not
exceed 987 grammes (35 ounces), being less by 400 grammes
(14 ounces) than the average weight of the brain in men of fifty
years of age.

M. Broca then compares the result of the autopsy with the clinical

.1868.] *y Da. FEBDEEtc BATBiiAN. 525

t)bservations during life ; lie considers that the primary seat of
mischief was probably in the third frontal convolution, extending
gradually to the others, and that this process of disorganisation
corresponded to the first stage of the clinical: history, which la3ted
ten years, and during which period the faculty of speech alone was
abolished, all the other functions of the body being intact ; the
second stage, which lasted eleven years, and which was characterised
clinically by partial paralysis, and then complete hemiplegia, he
connects with the extension of the disease to the island of Beil and
to the extraventricular nucleus of the corpus striatum.

A man, aged 84, formerly a navigator, was admitted into the sur-
gical ward at Bicetre on the 27th October, 1861, for a fracture of the
neck of the femur. This man had been received into the tospital eight
years before for senile debility, there being at that time no paralysis, and
the organs of special sense and the intelhgence being unimpaired. In
the month of April 1860 whilst descending a staircase he fell,
suddenly became unconscious, and was treated for what was con-
sidered to be an attack of apoplexy ; in a few days he was conva-
lescent, there never having been the least symptom of paralysis of
limbs, but since the fit he had suddenly and definitely lost the
faculty of speech, being only able to pronounce certain words
articulated with difi^culty ; his intelligence had received no appreciable
shock ; he understood all that was said to him, and his brief vocabu-
lary, accompanied by an expressive mimic, enabled him to be
understood by those who lived habitually with him. He continued
in this condition up to the time of the accident which caused him to
be transferred to the surgical ward under the care of M. Broca, to
whose questions he only answered by signs, accompanied by one or two
syllables pronounced hastily and with visible effort. These syllables
nad a definite meaning, and consisted of the following French
words — ^^oui, non, iois (for trois), and tovjoun!* He also pos-
sessed a fifth word, which he only pronounced when he was asked
•his name, he then answered '' Lelo,^' for Lelong, which was his
proper name. The three first words of his vocabulary corresponded
each to a definite idea. When he wished to affirm or approve he said
'* (mi^^ employing the word '' non " to express the opposite idea.
The word " tM' expressed all his ideas of numbers, but as he was
aware it did not correctly convey his thoughts, he rectified the error
by gesture : for instance, when asked how long he had been at
Bicfitre, he answered tois, but raised eight fingers. When asked
what was o'clock (it being then ten) he answered tois, and raised
ten fingers. Whenever the three other words were not applicable,
he invariably used the word totyours, which consequently for him had
no definite meaning. There was no paralysis of the tongue, which was
protruded straight, and was moveable in every direction, each half
Deing of the same thickness ; sight and hearing were good, degluti-

526 AphaiiOf Or LoH €f SpeeA in Cerebral Disease ; '[Jm,

tion was nonnal^ and there was no paralyaia of Smbs, nor of the
Motam or bladder.

M. Brooa sams up the symptcoiis by caQiDg attention to the fol-
lowing salient points : 1st, that the patient understood all tiiat wu
said ; 2nd^ that he applied with discretion the four words of fatt
Tocabulaiy ; Srd, that his intelligence was unimpaired ; 4thy that he
understood numbers; 6th, that he had neither lost the generd
fEusultj of language nor the movement of the muscles concerned in
phonation and articulation ; and that therefore he had only lost the
faculty of articulate language. The patient died in twelve days.
Autopsy. — ^The bones of the cranium were somewhat thickened, and
all the sutures ossified ; the dura mater was healthy ; the axaehnoid
cavity contained a considerable quantity of serum ; the pia nuto
was neither thickened nor congested. The enoephalon wtjgfaed,
with its membranes, 1186 grammes (40 ounces), bein^ feur beknr
the average weight of that of adult males. The right hemu^her^
the cerebellum, the pons vardii, and the medulla oblcn^ta, were
in a perfectly normal condition. In the left honisphete the lesion
was limited to a loss of substance in tiiid posterior M/rdrtsfile second
and third frontal eowvolutions, a small cavity having been thus
formed which was filled with serum. The walls of the cavity and
the neighbouring cerebral tissue were firmer than usual ; Uiere were
present some httle spots of an orange-yeUow colour, apparently of as
haematic origin, and microscopic examination revealed the presence
of blood crystals. The lesion then was clearly not softening, but the
seat of a former apoplectic clot ; and it wiU be remembered that the
patient suddenly lost his speech in an attack of apoplexy ei^bteea
months before his death.

In alluding to the above two cases, M. Broca says that in the
first case — that of Laborgno— it is only by comparing the di£Pereiit
stages of the disease as observed during life with the post mortesi
appearances, that he assumes the high probability of the lesioa
having commenced in the third frontal convolution; but in the
second case — ^that of Lelong — ^there being no other symptom than
loss of speech, and the lesion being strid;ly limited to the second
and third frontal convolutions, he considers the aphasia was incon-
testably due to disease of that portion of the nervous centres.
Whilst admitting that two cases are insufficient to resolve one of
the most obscure and disputed questions in cerebral patholc^, M.
Broca considers himself justified m asserting that the int^rity of the
third frontal convolution (and perhaps of the second) appears in-
dispensable to the exercise of the faculty of articulate language.'^

A later writer of the French School, Dr. J. Talret, has collected
from various authors no less than sixty -two cases, in the arrangeaent

* ' Sor le Si^ge d« la Faculty du Laagage Articule/ p. 39.

1868.] by Dr. Frbderic Batemak. 527

of which he ftdopts the following classificatioii : Ist^ all thode cases
in which the patients, whilst retaining intelligence and integrity of the
organs of phonation, can only remember or articulate spontaneously
certain words or classes of words, or even certain syllables or letters,
but who can repeat and write any word that may be suggested to them
by others. %vA. Those who are only able to pronounce sponta-
i^ously certain words, syllables, or phrases dways the same, not being
able to repeat other words dictated to them, and who yet retain the
power ot writing, or even of reading. 3rd. Those more rare cases
in which the patients can only pronounce certain words always the
same, which, aided by gesture, enable them to express their thoughts,
the power of readhig, writing, and repeating words dictated being
abolished. Dr. Falret admits that this class^cation is artificial, and
probably does not embrace all the varieties met with in practice."*^

Professor Trousseau has made this subject a promiuent feature in
his clinical lectures, where he details several most interesting cases
in which, when hemiplegia existed, it was with one exception always
on the right side.t

During several months of the session of 1865, the French Academy
of Medicine became the arena for discussion upon this most inte-
restii^ subject, in which many of the leading physicians and sur-
geons took a j^. At one oi these meetings M. Trousseau gave
the result of his statistical researches, and stated that in 134 obser*
vations collected by himself, 124 were confirmatory of M. Dax's
proposition of localizing the faculty of speech in the left hemisphere,
and 10 were contrary. With regard to M. Broca's theory erf
ftttributing aphasia to a lesion of the third frontal convolution, he
found that 14 cases were in favour of it, and 18 opposed to it;
i&mongst the latter he mentioned the case of a woman treated at
La Salp^triere by M. Charcot for right hemiplegia with aphasia,
and where after death there was found a lesion of the left insula,
and also of the third frontal convolution of the right side.

M. Trousseau also cited a case observed by M. Peter, the subject
of which was a woman who had left hemiplegia, and who could
only slay, " 0»f, parhleu r who died from the effects of senile gan-
grene, and at whose autopsy a lesion was found of the third frontal
convolution of the fight side, also of the insula and of the posterior
part of the corpus striatum, there being also embolism of the middle
cerebral artery. Here, says M. Trousseau, are two cases of aphasia,
with a lesion on the right side.

At another of these discussions M. Velpeau alluded to the fact of
M. Bouiilard having offered many years since a prize of 500 francs
for any well authenticated case in which the two anterior lobes were
dstroyed, or more or less seriously injured, without speech being

* ' Des Troubles da Langage/ p. 5.
t * Clinique M^dicale,' torn, ii, p. 571.

528 Aphasia^ or Loss of Speech in Cerebral Disease; {Jaii.i

affected^ saying that he (M. Yelpeaii) should claim the prize on the
faith of the following case, with specimen, which he presented to
the Academy twenty-two years ago. In the month of March, 1843,
a wigmaker, sixty years oi age, came under M. Velpeau's care for a
disease of the urinary passages. With the exception of his prostatic
disease, he seemed to be in excellent health, was very lively, cheerfal,
full of repartee, and evidently in possession of all his faculties ; one
remarkable symptom in his case being his intolerable loqua^ty, A
greater chatterer never existed; and on more than one occasion
complaints were made by the other patients of their talkative neigh-
bour, who allowed them rest neither night nor day. A few days
after admission this man died suddenly, and a careful autopsy was
made, with the following results: — Hypertrophy of the prostate,
with disease of the bladder. On openmg the cranium a scirrhous
tumour was found, which had taken the place of the two anterior
lobes ! Here then was a man who up to the time of his death
presented no symptom whatever of cerebral disease, and who, far
m)m having any lesion of the faculty of speech, was unusually
loquacious, and who for a long period prior to his decease must have
had a most grave disease of the brain, which had destroyed a great
part of the anterior lobes. The debate at the Academy of Medicine
closed without this learned body having arrived at any definite
decision in reference to the localization of the faculty of speech.

Several very interesting observations have been recorded in the
the French press, most of which are more or less corroborative of
Broca's views, or at least of the association of loss of speech with
lesion of the left hemisphere.

In the ' Gazette des Hopitaux' for July 1st, 1865, Dr. Lesur
mentions a remarkable case of a child, who, m consequence of a frac-
ture of the frontal bone caused by a kick from a horse, was trepanned
about one inch and a quarter above the left orbit. The child
recovered, but during the progress of the treatment it was observed
that pressure on the brain at the exposed part suspended the power
of speech, which returned as soon as the pressure was removes.

Another case of traumatic aphasia has recently occurred in the
practice of Dr. Castaffuon, the subject of it being a young girl, aged
20, who was shot in the head, the accident resulting in a comminuted
fracture of the antero-superior portion of the left parietal ; although
there was no depression of bone, several spiculse were removed, and
there was subsequently hernia cerebri and sphacelus of the protruded
portion, which was removed by ligature. There was a comatose
condition for six days, dextral paralysis and complete loss of speech
for a month, at the end of which time she could speak, her vocabu-
lary, however, being limited to four phrases, " Mon Dieu I Jesus I
monphe^ ma phre" At the expiration of a year the paralysis

1868.] by Db. Predebic Batsman. ^ 529

had subsided^ and the patient resumed her occupation^ but although
the intelligence was as perfect as before the accident, the young girl
^poke but very Uttle, and with great difficulty.*

An interesting case was observed a few months since at the Hos-
pital St. Antoine by M. Jacoud, the subject being a man aged 44^
suffering from Bright^s disease, who, without any premonitory symp-
tom, suddenly became aphasic, there being no other paralytic symp-
tom except a limited facial paralysis. The aphasia was of short
duration, and at the end of five weeks he spoke nearly as well as
before, but soon sank from disease of the kidneys. At the post-
mortem there was observed fatty degeneration of both kidneys;
insufficiency of the mitral valve, which was covered with small vegeta-
tions ; the arteries of the circle of WiUis were healthy, and there was
no disease of the grey matter of the convolutions, but there was a
limited and well-defined softening of the white substance in the im-
Inediate neighbourhood of the third frontal convolution of the left
anterior lobe, great stress being laid on the fact that the convolution
itself was in nowise affected.f

The next three cases I have to mention are instances of the lesion:
of the third frontal convolution without aphasia, but as the lesion
was on the right side, they may be adduced as negative proof % of
the truth of M. Broca's theory.

M. Fernet has recorded a case of left hemiplegia without aphasia
in a female aged 36, and at whose autopsy the entire frontal lobe of
the right hemisphere was broken down by softening. In the ' Gazette
Hebdomaire' for July, 1868, M. Parrot relates a case of complete
atrophy of the island of B«il, and of the third frontal convolution on
^ft right side, with preservation of the intelligence and of the faculty
of articulate language. M. Charcot has recorded the case of a wo«
man, 77 years of age, who had left hemiplegia without embarrass^*
ment of speech, or loss of the memory of words, and at whose
jautopsy there was found yellow softening of the surface of the right
frontal lobe, the second and third frontal convolutions being com-
pletely destroyed, and there being no lesion of the central parts of the
brain.

I need scarcely remark that cases like the three just mentioned,
of lesion on the right side without aphasia are quite as valuable
in a statistical point of view, and tend as much to settle the quastio
vexata, as cases where the converse condition exists, viz., lesion ou
the l^ side with aphasia.

I now arrive at a class of cases which have a directly opposite
pathological signification to those above mentioned, the six following
observations being all calculated to invaUdate the recent theories as
to the seat of articulate language.

• ' Gazette des Hopitaax,' Oct. 12, 1867. t Ibid., May 16, 1867.

530 Jpkasia, or LoM of Speech in Cerebral Disease ; IJxa,,

. M. Peter relates the case of a man who fractured his sknll by aM
from a horse. After recovery from the initial stupor there succeeded a
remarkable loquacity, although after death it was found that the two
frontal lobes of the brain were reduced to a pulp {r^tits en bauilUe).

In Trousseau's ^Clinique M^cale/ the following case is re-
corded : — In the year 1825, two officers quartered at Tours quar-
relledj and satisfied their honour by a duel, as a result of which one
of them received a ball which entered at one temple and made its
exit at the other. The patient survived six months without any sign
of paralysis or of lesion of articulation, nor was there the least hea-
tation in the expression of his thoughts till the supervention of in-
$ammation of the central substance which occurred shortly bdbie
bis death; when it was ascertained that the ball had traversed the
two frontal lobes at their centre.

M. Charcot^ who has collected a number of observations more or less
corroborative of M. Broca's assertions, has however recorded the case of
a woman, aged 47, who from a fit of apoplexy suddenly became bemi-
plegic on the right side and aphasic. Her intelligence was unaffected,
and memory reported as good, but her articulate language was reduced
to the monosyllable " Ta,'^ which she was in the habit of repeating
several times over {" Ta, ta, tm ta^')^ v^fy rapidly and very distinctly,
every time she tried to answer any question or to ocnnmunicate her own
ideas; the tongue was perfectly free, and could be moved in ev^ry direc-
tion. After death it was found that softening had destroyed the first
and second convolutions of the temporo^sphenoidal lobe, the island of
Eeil, the extra-ventricular nucleus of the corpus striatum, and the
intraventricular nucleus in its posterior half, the optic thalamus being
intact; the frontal convolutions presented no alteration either in
volume, colour, or consistence, the examination being conducted with
with the greatest care, and even in the presence of M. Broca, who
frankly admitted this case to be at variance with his hjrpothesis.^

A womaU; aged 73, was admitted into the Salpdtriere under M.
Yulpian, her only symptom being loss of the power of speech,
there was no pardysis of limbs, and M. Yulpian looked upon thia
patient as a type of aphasia. After a few days she became hemi-
plegic on the right side, and died of pneumonia five weeks after ad-
mission. At the autopsy softening was observed to a consid^able
extent in the posterior half of the supraventricular white matter of
the left hesrisphere, there being not the slightest indication of any
lesion of the frontal or other convolutions.; there was, however, ob«»
struction of the left middle cerebral artery, caused partly by atheroma-
tons thickening of the walls and partly by a fibrinous deposit evidently
of a recent date, the result rather of a thrombosis than of an embolism.
^ A navigator, aged 42, was admitted into the H6tel Dieu, under the

* Broea, op» cit., p. 6. . -

1868.] ly Dr. Fbedbbic Batbmajst. 531:

oiM^ of M. Troosseau^ on 25th March^ 1865. The sister of the
ward^ deeming him to be in extreme danger, began to exhort him^
to think about his last nK>ments> when she received for an answer,
^* IPy a pas de danger" Soon aftearwards the dresser arrived, and
to hjs first question the patient replied, ^^ N'y a pas de dan^J'
Seeond question, same answer. It was evident that the man was
»)hasio, mA the discovery that there was paralysis of the right side
of the body coijfinned the diagnosis. There was marked rigidity of
the right upper extremity, the forearm being strongly flexed upoft
tb/9 arm ; the tpngue was protruded straight, and was freely move«
aUe ; tiie right h^of the face was paralysed, but the orbicularis pal-^
pebrprwn wa^ unaffected. Some weeks after admission he $eems to
have forgotten his old formula, for to f.very question he anpw^rad*
''Tout de meme.^' Death occurred after four months' residence in
the hospital, when the necropsy gave the following results. Almost
the entire left hemisphere was converted into a vast cavity, having the
appearance of a true cyst, the walls of which were formed above by a
very thin layer of cerebral matter flattened and even softened,
and which was adherent to the much-thickened pia mater ; in
front and behind, aU the remaining cerebral substance was yellowish
and much softened. The orbital convolutions, the island of Eeil,
and the first and second frontal convolutions were in a perfectly nor-
mal condition ; the third frontal convolution was pronounced healthy
in that portion (the posterior third or half) which bordered the fis-
sure of Sylvius and the furrow of Rolando, but it was evidently
softened and almost destroyed in its upper part, where it was included
m the general softening of the hemisphere, which also involved the
corpus striatum and the thalamus opticus j the middle cerebral artery:
was not obUterated. This examination was made in the presence of
Professors Trousseau and Guillot, and whilst showing the care with
which this subject is being investigated by the French faculty^ it
possesses an additional interest from the fact that when the autopsy
waa completely finished and the brain mutilated by the successive
slices that had been made, M* Broca arrived, and declared that the
postero-e:^tema]. part of the third frontal convolijtion was yellow
and softened, and that it had been thought healthy because it had
been looked for where it did not exist V^

The last case to which I shall allude under this head is recorded
by M^ Lwigaudin of Nice, the subject of it being a soldier, who dis-
charged the contents of a pistol through the mouth, the ball travers-
ing the arch of the palate in the median line ; the patient lived
two months, and speech was unaffeeCed, although after death it waa
fowid that the anterior lobe of the left hemisphere was entirely des-
troyed by suppuratioft.t

* ' Gazette des Hopitaux/ Sept. 28, 1866. f IWd., April 29, 1865.

&32 Oecoiianal Notes of the Quarter. [Jin.,

I conclude the history of the French contributions to the literature
of aphasia by a brief allusion to Dr. Ladame's essay on lesions of
speech in connection with tumours of the brain. Prom his researches
it would seem that derangement of speech is not common in cerebral
tumours^ he having observed it only 44 times in 332 observations.
According to Dr. Ladame^s valuable statistics, tumours of the corpus
striatum and of the pons varolii are more frequently attended by loss
of speech than those occurring in any other part of the encephalon.
He found that tumours in the middle lobes were more frequently
accompanied by lesion of speech than those occupying the anterior
bbes, in the proportion of five to four. These curious results have-
led Dr. Ladame to dissent from the doctrine which would place the
seat of articulate language in the anterior lobes.

{To be continued.)

OCCASIONAL NOTES OF THE QUARTER.

Tie Sanity of Louis Bordier.

The trial of Louis Bordier, a Frenchman, for the wilful murder
of the woman with whom he had cohabited for thirteen years, has
alSbrded another painful illustration of the extremely unsatisfactoiy
method of procedure followed in our courts of justice when the
insanity of the prisoner is suspected or alleged.

There had been occasional quarrels between him and his paramour;
he was unable to support her, and she was resolved to leave him.
Bordier deUberately aetermined to cut her throat, the throats of their
three children, and finally his own throat. This resolution he com«
municated in a coherent letter addressed to his brother, and written
on the night of the murder — ^the night before the woman was to
have left him. He wrote : — I have taJken the resolution for the last
fortnight of taking awav my life as well as that of the woman with
whom I have lived for thirteen years, as also those of my children.*'
The reason which he assigned for this determination was '' to save
myself as well as my family from misery .'* He hopes that Gted will
pardon him '^ the sin he was going to commit,'* and begged ''those
gentlemen of the jury who will make inquiry over me not to return
a verdict ' that this man is insane,' as it is said, I believe, always^
I have all my faculties at the moment that I write these lines.''
Courage failed him to carry his resolutions into effect fiilly — he cut

J.868.] Occasional Notes of the Quarter. 538

the poor woman^s throat while she was asleep in the night, but the
sight of the blood so unnerved him that he proceeded no further
than the first act of the tragedy.

There could be no question as to who was the murderer, for
Bordier calmly acknowledged what he had done ; nor could there be
any doubt of the crime having been premeditated, and deliberately
perpetrated, with a full knowledge of its nature. The defence set
up for the prisoner was that of insanity — ^a defence, unhappily, so
often made the last resource in a desperate case. The only evidence
in support of the plea for the defence was that of Mr. George
Simpson, a practitioner in the Old Kent-road, who had been called
in at the time of the murder. It was as foUows : —

Mr. George Simpson. — I am a physician and surgeon in the Old Kent
Road. On the morning of the 3rd of September I was called to the house
about a quarter past six o*clock, and found the deceased lying on a bed. She
was still alive, but insensible. There was an incised wound on the throat,
which divided the windpipe and arteries. It commenced under the ansle of the
right jaw, and went downwards in a slanting direction. It was about six inches
in length and two inches in depth, and was the cause of death. I met the prisoner
with the constable on the stairs, and I asked the constable who he was. The
constable replied, " This is the man who did it, sir." The prisoner said, ** Yes,
I am the man.** I allowed him to pass me on the stairs. He went upstairs
and I followed him into the room where the deceased lay. He said to some one
who stood in the way, *' Allow me to pass,** and then went to the bed, and
leaning over it kissea the deceased. He went out of the room, and said to
some one on the landing, " I have written a letter to my brother, telling him
what to do, after I have carried out my plan, with any of the children that
may be left." He mentioned some one who would translate the answer.
He kissed one of the children that was brought to him, and then walked
downstairs. I followed him. He sat down on a chair, and took out his pipe.
The constable was present. I asked the latter where the instrument was
with which the crime had been committed. He took it from his pocket. It
was then covered with blood, coagulated, but not dry. The prisoner imme-
diately rose from his seat, and came over to the policeman and me. I was
looking at the knife in the policeman's hand. The prisoner said, " That is the
knife, you know, I brought home on Saturday on purpose to do it with."
After looking at the knife I said I wondered how the body was lying when
the crime was committed. The prisoner rose from his chair and said, "I
shall show you all about it." He then proceeded to tell me how the crime
was committed. He said, ** I got up about four o'clock, but my wife awoke
and requested me to come to bed again, it being so early. I did so, and
waited a little time until she fell asleep again. I then arose cautiously,
stood in front of her, kissed her, shook her hands, and drew the knife in this
manner (indicating it by a movement of his hand). Then,*' he said, **the
blood came, which I did not expect." I said, "Did you not know there was
blood in a human body ?*' He said, " Oh, yes, I knew that." I said, ** Did
you not expect it in that of your wife?" He replied " No, I cannot say I
did." He then said, '* She looked towards that door (pointing to that of a
room in which the children lay), intending to go there, but of course my
plan was that we should all die." He went to the door and showed me how
he prevented her going in. He said, " She then went upstairs. I now," he
continued, " intended to cut my own throat, but the blood prevented me." I
said "How? The siriit of it?" He replied, ''No, it stood up like a

xm. 37

534- Occasional Notes of the Quarter. [Jan.,

pillar or barrier/* indicatiDg by his hand what he meant, and that mm that
the pillar stood between his own throat and the razor. He added, " Of
course I cannot do it now. Some one will have to come aad cot mj throat, for I
cannot do it. I ought to have done it in another way, but had no material."
I said, " Firearms I " He said, *' Yes, I suppose wA most have been it."
He said that on drawing the knife it was WT hard to do. I asked wkat
ever made him think of doing such % ^I>|jy* He said, '* It was a necessity^
sir ; it was necessary for me to do it.'* He hesitated a minute, upon which
I said, " You looked upon it as a duty, I suppose ?** He said, " Yes, de*
cidedly. It was right, was it not?*' I asked why he had considered it
a necessity. He replial, " Well, I shall not tell you now.'' The constable
handed me the letter to which he has referred. Ihe prisooer, who was then
smoking, rose from his seat and said, *' Yes, I wrote that letter on Sunday
night." He repeated the substance of the letter, as to what he expected his
brother was to do with the children. He said, '*Ionly wrote it on Sunday
night, although I had made up my mind a fortnight before to kill myself;
bat I could not part with my wife, and therefore I determined that she should
die too, and go with me, as also the children." I asked him a little about
his health, and to sit down. I inquired how he had been for some time. He
1 eplied, *^ Bad, very bad," adding that he had been operated upon. I again
asked him how his health now was. He immediately said, '* Ob, I am not
insane." I looked at his tongue, felt his pulse, and put a few questions to
him. I asked if he had sweated at night. He said he thought he had. I
asked him in what state his mouth was when he got out of bed. He saidi
•* Very dry." I said, ** Parched ?*' He replied, ** Yes, exceedingly so." He
said bis appetite was bad. I asked if he bad any singing noises in his ears.
He said he thought he had, but he was not very sure about that. I asked
what time had elapsed since the operation was performed. He said he
thought a few months. I said, ** The disease must have been fistula." He
replied that he thought it was. As to the wound, several arteries were
severed, and also the veins. The blood frou^ the arteries would spurt
towards the chin unless the edges of the wound stopped it. There was no
blood upon him, except a little on his shirt sleeve, as if it had been rubbed
off anotner body.

In cross-examination by Mr. Sleigh, witness said he had studied insanity as a
science. He is a surgeon and also a physician. Fistula was of a decidedly de-
pressing nature, as was also the system which generated it. The disease was the
result of a general disorganization of the system — the tubercular system. Some
diseases bad a more depressing effect on the mental condition than others.
Fistula was one. From his examination of the prisoner, and taking the
attendant circumstances into consideration, he had formed an opinion as to
the state of the prisoner's mind. That opinion was that he was insane at
the time be conmntted the act and when witness was conversing with him.

By Mr. Poland, in re-examination. — AVitness had read the letters, and
should say the prisoner at the time he wrote them had not the power to do
right, and did not know be was doing wrong. The letters were the offspriug
of a delusion — namely, that it was necessary he should die. There was a
recognised form of insanity of that kind, and he was distinctly labouring
under it. His manner and appearance indicated insanity. Witness be-
lieved that in him there was a complete deficiencv of volition or control
over a perverted train of thought, and over the acts wnich were the expressions
of that form of thought, of which the crime itself was one. The prisoner
believed in the delusion of the blood from the throat standing up as a barrier.
Sane people were usually frightened at the sight of blood. Witness himself
had almost fainted at the first sight of it. The prisoner had an abstracted
appearance — a vacant look, without any appearance of moroseness. His tone
ot voice indicated insanity. It was that of a man who was thoroughly

1868.] Occasional Notes of the Quarter. 5&5

satisfied with what he had done, and expected it to be appreciated. His
manner was cool. He smoked a pipe, which witness snould not have
expected in a man who had committed such a crime, and immediately after
he had committed it. There was also his previous history, about which
witness inquired, and his extremely bad, consumptive state of health. (Mr.
Poland read to the witness the letter written by the prisoner on the Sunday
evening to his brother.) That letter, witness said, was apparently incon-
sistent with people's idea of insanity, but it was not inconsistent with the
insane themselves. The memory was not lost in insanity, but the will was in
abeyance. Insane people had written books. From his experience of the
insane the passage in the prisoner's letter wishing to save his children the
pain of hearing their father branded as a murderer did not alter his opinion,
It did not show the prisoner was aware of the difference between right and
wrong, but only that his memory of language was in active operation and
perfect. Witness had been eight years in practice as a general practitioner.
He had had experience in the treatment of lunatics, and had now two
patients suffering from delusions.

Replying to Mr. Sleigh, he said he was both a member of the College of
Surgeons and of the College of Physicians. Several hundreds of insane
people had come under his cognisance. He had intended at one time to
follow the study of insanity as a specialty. He should expect an idiot to
know that murder was a crime, and still commit it. Judging from the letter,
he should conclude the prisoner knew he was going to commit a crime
against the laws of God and man ; but from his experience of what he had
known insane men write, and do after they had so written, he should expect
that he had not the power to appreciate the legal quality of the act. As to
the expression in the letter, in which he said he had all his faculties about
him, witness should have been disappointed if he had not written that, for
insane men always thought they had all their faculties about them. When
he said to witness he was not insane, it was to him an additional proof that
he was insane, considering the manner in which he said it, and his appearance.
It was difficult to describe the appearance of an insane man, but from
witness having seen 400 or 500 insane people in his time, the prisoner gave
him the idea of an insane man.

By Mr. Poland. — He was thirty-five minutes in the prisoner's company,
and did not see him afterwards until he was at the police-court and now.

The surgeon and the governor of Horsemonger Lane Gaol and the
surgeon and the governor of Newgate Prison gave evidence that they
had seen the prisoner daily while he was under their care, and that
they had observed no indication whatever of insanity. After the
usual trite observations regarding the criterion of legal responsibility
by the counsel for the prosecution, and the usual vague and
passionate appeal by the counsel for the defence, both gentlemen
evincing their entire ignorance of the nature of insanity, the
presiding judge summed up in an impartial and careful manner, and
the jury, after a short deliberation, returned unanimously a verdict
of Guilty, Bordier was sentenced to be hung, and the sentence was
carried into execution on October 15th.

We cannot be at the pains to analyse in detail Mr. Simpson's
evidence — the only evidence in support of the plea of insanity — or
to comment upon his manner of searching for and discovering indi-
cations of insanity. His evidence certainly contained something

5S6 Oceasioual Noiet of the Quarter. [Jan.^

which is true of insanity abstractedly, but very little, we think,
which was true of the concrete case to which he made so violent an
application of his theories. It is to be regretted that Mr. Simpson
had not a much greater experience of insanity than he had, or that he
had any knowledge of it at all ; for it is impossible to help thinking
that his judgment suflFered by reason of the little knowledge which is
a dangerous thing, and the bias resulting therefrom.

The following remarks on the trial, which appeared in the
' Medical Times and Gazette,' so nearly express our sentiments, that
we take the liberty of quoting them : —

The only evidence of insanity given was that of the surgeon called to the
house at the time, Mr. G. Simpson, of the Old Kent Road, and some per-
fectly coherent letters written by the accused to his brother prior to the
murder, in which he complained of having submitted to much misery for
eight months past, and expressed his intention to kill his wife and children
and then to take away his own life, stating that he had determined upon tbifl
a fortnight previously. The^ are the letters of a man completely in his
sound mmd, but utterly devoid of any proper sense of religious obligatioo or
proper moral training. And that is all. They plainly state that he was
about to commit the crime contemplated to save himself from misery as well
as his family. More than anvthmg else, they put one in mind of similar
letters not uncommonly found when a Frenchman and his paramour have
agreed together to commit suicide by the fumes of burning charcoal. Mr.
Simpson said that these letters did not at all affect his opinion that the man was
insane, and that he considered they were written under a delusion. When
asked by the counsel for the prosecution, he explained that the delusion was
*' that he must die, and that it was necessary he should die, which was a
very common form of insanity.*' To this explanation we must demur. The
man gave distinctlv a reason for his meditated crime — namely, the misery he
was suffering ; ana no doubt he had suffered. Three months previously he
had been in hospital for anal fistula, and although the bodily sufferins had
probably been relieved by the operation he underwent, it is not at all un-
likely that the associated mental depression had not simultaneously disap-
peared. Such a consideration may be a fair ground on which to urge a
commutation of the sentence of death, but it is not an argument to be used
in support of a plea of insanity, except collaterally to other proof of a more
decided character. And no such proof was forthcoming, llie two
governors and the two surgeons of the prisons in which Bordier had been
confined since his crime had failed to perceive the least indication of mental
disease, nor did the counsel for the defence presume to call witnesses in
support of their allegation. They relied alone upon the letters and the
opinion given by Mr. Simpson. And now let us see how Mr. Simpson's
opinion was formed upon a matter respecting which a medical man cannot be
too cautious, too diligent in inquiring into ail the physical and mental ante-
cedents in the life and habits of the individual in question, or too protracted
in his personal observation. Mr. Simpson, it appears, saw the man shortly
after the commission of the crime ; he confessed to him that he was the man
who did it, and showed him pantomimically how he did it. Such conduct
and his coolness and self-possession at the time were quite in accordance
with the letters put into court. Both, however, are, to Mr. Simpson's mind,
indications of insanity. It is to be observed that Mr. Simpson had never
had anything to do with the man before, and was only in his company
thirty-five minutes. Yet this time was sufficient to convince him of the
man's insanity, and even lo d^t^ixiidtv^ thie special form of insanity he was "

1868.] Occasional Notes of the Quarter, 587

labouring under. ^ First of all, in Mr. Simpson's opinion, the man*s manner
and appearance indicated insanity. So also did the tone of his voice — " It
was that of a man who was thoroughly satisfied with what he had done, and
expected to be appreciated.*' Hence it seems clear that Mr. Simpson started
with a prejudice in favour of the man's insanity, and the suggestive style in
which he stated at the trial that he proceeded to question him — a style never
admissible when the simple truth has to be elicitea — was such as not unnatu-
rally issued from such a preconceived notion. Is it any wonder that —
f(H'getting that a foreigner has not the command of our language that an
Englishman possesses— %e discovered in the answers he received a confirma-
tion of the view he had adopted ? We shall not reprint all these questions
and answers, inasmuch as they by no means tend to exhibit professional
investigation in the most favorable light, or to lessen that distrust in medical
opinion so commonly expressed both from the bench and by the bar in
lunacy investigations. Perhaps the most extraordinary part of thafc gentle-
man's evidence, as given in the 'Times,* was this — that, '' judging from the
letter, he should conclude that the prisoner knew he was going to commit a
crime against the laws of God and man, but from the experience of what he
had known insane men write and do after they had so written, he should
expect that he had not the power to appreciate the legal quality of the act."
We can scarcely believe that this is a correct report of what Mr. Simpson
said, for if it is it shows a confusion of ideas which must have been apparent
at once to the legal minds engaged in the trial, if not to the jury. A man
knew he was about to commit a crime, and yet did not know the legal quality of
the act — that is, did not know it to be criminal. We are not disposed to lay
entirely at the door of the medical profession all the absurdities they are
taxed with, and all the mistakes they commit when called upon to give
evidence in courts of justice. The legal theory, as well as the popular
notion, appears to be that by virtue of his diploma to practise medicine, and
also by virtue of his experience in the course of his practise, any general
practitioner or physician ought to be qualified authoritatively to instruct the
court by his skilled opinion upon all matters coming under its cognisance in
the prosecution of criminal business that relate to the structure and
functions of the human body, the detection and mode of action of poisons
and other agencies producing death, and even to the most delicate psycho-
logical questions. The sooner this notion is dispelled, the better. It is true
that although psychology forms no part of medical education in this country,
instruction in medicine and surgery as they apply to such matters is given in
the schools, but, like that given upon other subjects, it is, and, in the time
allotted to study before examination, can only be, elementary ; and after
receiving his diploma a medical man, in ninety -nine cases out of a hundred,
has quite enough to do in gathering experience upon those practical matters
which relate to his daily duties, the cure or alleviation of disease. It is no
slur upon the profession, then, to say that every member of our hard-working
and, in its own strict department, highly trustworthy community, is not
fitted to give an opinion upon subjects which, perhaps, he is not called upon
to consider once in a year. Our members are placed by the law and custom
in a wrong position, unfair to their body at large ana unfair to themselves
separately, and hence in one which leads them not rarely to bring medical
learning generally into disrepute. From such a position those engaged in
the ordinary practice of medical art ought to seek release, if not for their own
reputation's sake individually, which is far more valuable than the paltry
gain attaching to the present system, yet assuredly for the reputation of the
order to which they belong. In the meantime, it would be far better to
acknowledge incapacity where incapacity is felt, certainly to avoid volun-
teering opinions upon such delicate questions as the insanity of an accused

6SS Oeeasiaual Noiea cf tie Qtmitt. [Jan.,

person. In the case before us we gire Mr. Simpson full credit for tlie most
excellent and kind motires and for full belief in his own theory, but we say
that it b to be r^^^tted that he compromised the profession by giving ex-
pression to an opinion in itself crude and unphilost^hical, and formed upoa
what appears to ha?e been a rery brief and inadequate inquiry.

Holding opinions agreeing in the main with those expressed in
this article, we are sorry that we feel compelled to differ from the
view of Bordier's crime taken hy some of onr associates. Dr.
Lavcock, Dr. Wood, and Dr. Harrington Tuke have addressed
letters to the medical journals, expressing their convictions of
the insanity of Bordier. We reprint these letters at length, in
order that our readers may have the full advantage of the argu-
ments which they contain. Dr. Laycock writes as follows to the
' Medical Times/ commenting upon remarks which had appeared in
that journal : —

Sib, — Will you pardon me the expression of my dissent from the opinions
expressed under '* Topics of the Day" r^arding the case of Louis Bordier
and the principles of jurisprudence in cases of alleged criminal lunacy ? I
have not seen the letters published in the * Morning Star' to which you refer,
but the quotations the writer gives us are sufficient for my purpose. It
appears that Mr. Gowlland, the surgeon who attended Louis Bordier for
&tula, has observed " great despondency" in these diseases of the rectum,
and " melancholia and suicidal mania as a result." Upon this statement of
facts the writer comments thus : — ** Now, this kind of evidence appears to us
very dangerous. The theory that connects homicidal mania with fistula is
certainly novel. If it be a true one, St. Mark's Hospital ought to be placed
under the Commissioners of Lunacy, and no patient should be allowed to go
from it except under surveillance." Upon reconsideration of the matter,
your writer will perhaps see that Mr. Gowlland states no theory of " kown-
cidal mania,'* but states as a fact within his experience that these diseases
are not uncommonly associated with despondency, and with melancholia
and suicidal mania as a result. It is much the same as if a practitioner had
stated as a fact within his experience that parturition and mania are not
uncommonly associated. So that the jocose suggestion that St. Mark's Hos-
pital should be placed under the Commissioners m Lunacy would apply with
equal force to Maternity Hospitals. Why the facts stated by Mr. Gowlland
(the truth of which is not questioned) should appear very dangerous to the
writer is rather implied than expressed in the next sentences. '* The simple
question is — ^Did Bordier know that he was infringing the laws of the
country in which he lived when he cut the throat of his paramour? If he
did, he is amenable to those laws." Here the writer propounds a question
of legal responsibility, certainly simple enough, but at the same time so
comprehensive that three fourdis at least of the insane under detention in
hospitab or asylums would be hanged if found guilty of "homicidal mania.*'
At page 419 you record "a horrible case of child murder under the
influence of fanaticism or religious insanity.** No one with even but a
small experience of the insane can doubt the murderer was a lunatic. Tet
he knew well his wife would prevent him committing the murder, and when
she came in and found the deed done he said — *' Go to the mayor, and tell
him all," thus showing that he knew he was amenable to the laws, and there,
fore (following the legal dictum) legallv responsible. In truth, however, i\^^
nrriter objects " that there is absolutely no evidence of insanity in the case

1868.] Occasional Notes of tke Quarter^ 539

[of Bordier] besides his crime." Now, 1 must take the liberty of saying that
the facts, even as stated by the adverse writer, are conclusive, to my mind, to
the contrary. It is always more or less presumptuous to give an opinion on a
case without seeing the patient, but I think there is no one familiar with in-
sanity that will not agree with me in this opinion. The most dangerous
thing in these cases is that the miserable sufferers are allowed to suffer on —
suffering the greatest anguish that in my opinion human nature can suffer —
until they murder those that are dearest to them ; those, in short, for whom
in their sound mind they would have died. So constantly is this observed in
that particular kind of melancholia with which Bordier was affected, that it is
probable he had a strong affection for his paramour before his brain gave way.

It is an old complaint that to acquit murderers like Bordier, on the ground
of insanity, is very dangerous, because it tends to encourage murder by
lessening that fear of death which is the only restraint some men are capable
of. I am no advocate for the out-and-out abolition of capital punishment,
but I am also satisfied the legal dicta as to insanity and the responsibility of
the insane are wholly incompatible with that final resource of justice. Year
after year bloodthirsty leaders have appeared in the newspapers, calling for
vengeance on insane murderers, and year after year sensational paragraphs,
headed " The Murder Epidemic," have served to stimulate judges and juries,
and the insane have been duly hung as an example to others. Stubborn
facts incontestably prove, however, that it is a pure hypothesis to suppose
that it is expedient or useful to hang, or condemn to be hanged, miserable
wretches, from disease, want, and despair, that hardened healthy ruffians
may be frightened. To some minds, the uncertainty of the law must of
itself be a temptation to try the chances, for it is a mere chancfe whether a
man will be found guilty or not, or if found guilty whether he will be hanged
or not. A Prichara may think he has as good a chance of escape as another,
however insane that other may be.

It is " very dangerous" to perpetrate an outrage upon the fundamental
sentiments of justice. I know, indeed, no more miserable sight than to see a
poor lunatic or imbecile upon his trial for murder,, with a strictly legal judge
presiding, and mercilessly enforcing his knowledge-of-right-and- wrong dogma
against the uncomprehending wretch at the bar, with all the appropriate
technicalities. I do not blame him ; I feel convinced he is doing what he
strongly feels to be his duty in the repression of murder. Nay, I pity him,
for when he leaves his court and lays his legal technicalites aside, the thought
of the helpless, feeble-minded wretch that he has but lately condemned to
die touches his humanity, and awakens something like suspicious regret, if
not remorse ; and the morrow perhaps finds him pleading for the convict he
has sentenced to die.

One word as to these insane murderers. To them death ought to be wel-
come ; it often is very welcome ; and it is assuredly a happy release from a
state of terrible ansuish. Upon whom, then, does their punishment fall ?
Too often — too surely — upon their poverty-stricken widows and orphaned
children. Such is the kind of justice, as it appears to me, that your critic
pleads for. I am, &c. *

T. Latcock.

Dr. Wood^s letter is as follows : —

Si^, — Allow me to corroborate the statement contained in Mr. GowUand's
letter in reference to the case of the convict Bordier, on which you comment.
It is quite true that extreme mental depression not unfrequently attends
cases of fistula, and you may remember that, some ten years ago, a very sad
case occurred in the person of an Italian named Buranelli, who became
a patient in Middlesex Hospital on account of a very trifling fistula, and

640 Oeeoiional Notes of the Quarter. [Jan.^

wbose Ibind WM so much disturbed in reference to this fistnla tliat be main-
tained, afler it bad entirely healed, that his bed was sWamped with water
escaping through it. Buranelli also committed a murder, and Mr. Mitchell
Henry, the surgeon under whose care he had been in the hospital, was
so strongly impressed with the conviction that he was of unsound mind, that
be yoluntarily came forward, and at the trial gave the clearest evidence in
support of bis opinion. It was most properly pointed out that not only did
the wretched man entert-ain this distinct delusion, but that bis character was
changed, and that, being naturally mild and amiable, be had become violent
and ungovernable ; but, notwithstanding this, he was convicted and executed.
It is, then, of some importance to remember that the case of Bordier is not
used to support a new theory. The connection between fistula and an
unsound state of mind is an established fact, and the cases of Buranelli and
Bordier bear a striking resemblance to one another in various particulars.
I cannot conclude without protesting against the doctrine that, if a person
knows be is infringing the law, he is to be necessarily held amenable. The
experience of every one who has had to do with the insane will support me
in asserting that the great majority of insane persons know perfectly well
when they are doing what is forbidden, and that unless we are prepared to
ignore the mental condition of offenders, we must recognise the fact that
they are influenced by different motives from those which guide persons of
sound mind. Who shall say that a man, who is described by the surgeon
who has watched his case as " in a state of extreme mental and physical de-
pression," is of sound mind, and ought to be held responsible for his
irrational acts ? Surely hanging such a miserable being cannot be supposed
to be the duty of a Christian people; it is much more likely to excite
sympathy for the culprit than indignation for the crime. I am, &c.

W. Wood.

Dr. Harrington Tuke wrote to the ^Lancet* the following letter : —

Sib, — It is officially announced that the sentence of death upon Louis
Bordier is to be carried into effect on Tuesday next. There is but scanty
time to debate the question whether in his and other such cases strict law is
justice ; I would, however, ask jour powerful aid to bring under the notice
of the authorities the considerations that seem to me to render Bordier's exe-
cution impossible, without further inquiry into his mental state.

Bordier was arraigned on the 27th of September last, for wilful murder.
It was proved that he had cut the throat of the woman with whom he had
lived for thirteen years, and had intended to kill his three children by her,
and afterwards himself.

Dr. Simpson, the first medical witness /or the prosecution^ gave consistent
and unshaken evidence to the effect that he had found distinct delusion in
Bordier's mind ; he had read the letters written by the prisoner before the
murder, produced in court, and they evinced the presence of monomania ;
that the man's general appearance and manner were those of a lunatic ; and
the witness had no doubt that he was of unsound mind, and irresponsible
for his actions. Dr. Simpson mentioned, incidentally, that, although in
general practice, he had had considerable experience in cases of insanity.

Two other medical witnesses were called, one of them the surgeon of the
gaol. The evidence of these gentlemen was simply negative ; they had daily
seen the prisoner since his committal, but bad discerned no indication of in-
sanity ; they had not examined him as to any alleged delusions, nor as to the
causes or the circumstances of his crime.

The counsel for the prisoner pleaded insanity for the defence, but called
no witnesses, relying upon the evidence of Dr. Simpson, the insane nature
of the documents in court, and the general history of the case.

1868.] Occasional Notes of the Quarter. 541

Mr. Justice Montague Smith, in an able and impartial Btimming up, bear*
ing, if anything, to the side of mercy, left the jury to determine whether the
prisoner were insane or not, at the same time directing them to find him guilty
if they thought he knew at the time of the murder the nature and quality of
the act he had committed.

The jury unanimously brought in a verdict of " Guilty," and the judge
then, with " evident emotion," pronounced the sentence of death upon the
prisoner, who heard it with " stolid indifference," and, deaf to the " wailings"
of his two little girls, walked unconcernedly from the dock.

I believe, and I speak not without considerable experience of such dis-
eases, that Bordier is a '* monomaniac," and if he be hung the cruel absurdity
will be committed of inflicting capital punishment upon a lunatic, and fixing
upon his kindred the unjust stigma of relationship to a responsible and cold-
blooded assassin.

1 am aware it will be said that insane homicides, by the English law, are
responsible, and therefore Bordier is legally condemned ; but if so, why
should the prosecution by the crown be conducted as it was in this case, and
has been in other cases ? Why should not the lunacy have been admitted ?
The prosecution proved by their own witness, Mr. Simpson, that the prisoner
was msane, they brought forward no medical evidence to controvert this
opinion, except the negative testimony already described, and rested their
case entirely upon the fact, that, insane or not, the prisoner might and did
know that he was '* doing wrong."

I do not believe that twelve men could be found who would unanimously
bring in a verdict of wilful murder against a man actually, or even presum-
ably, of diseased brain, unless they were bewildered by the legal doctrine that
the prisoner's knowledge of the distinction between right and wrone is the
sole point to determine. There are few English juries who would fail to see
that, in the case of an insane man, the conclusion as to whether in a particular
act he knew right from wrong, is one that no jury can arrive at, and upon
which no doctor, specialist or otherwise, should venture to give a decided
opinion. Except upon legal grounds, no jury would find a madman guilty
of wilful murder. Judges are not less merciful than juries. In the case of
Hatfield the judge virtually stopped the trial upon clear evidence being
given that the prisoner was suffering under delusion. Recently, in the case
of Townley, the learned judge impressed upon the jury the importance of the
question as to whether the prisoner acted under " delusion ;" and although
the existence of any " delusion" was sworn to by only one unsupported me-
dical witness, who was, moreover, entirely mistaken, the judge caused fur-
ther inquiry to be made, and the prisoner was respited for that purpose. The
case of Bordier stands upon no imagined " delusion," or false theory of in-
sanity. The disease of brain in Bordier is shown by insane letters, by insane
words, by insane intentions, and an insane act. Then, in his case, why
should not inquiry be made ? If, after due examination, he be pronounced
sane, let him undergo his deserved punishment ; if insane, send him to a
criminal asylum ; or, if the law inexorably demands his life, let him be hung
as a declared '^ madman." Such an execution might lead to a revision of
that ruling of the twelve judges which make the knowledge of right and
wrong the test of responsibility; such a declaration will at least be common
justice to the prisoner's family. It may be some consolation to them to
think that there are some who, knowing the condemned to be insane, will
acquit him of any moral guilt in the deed for which he suffers.

It must be remembered that those who defend the justice and expediency
of condemning and executing a lunatic murderer can by no means ur^e that
English law certainly requires his death. It is true that the twelve judges
in recent days have decided that a lunatic is responsible if he knows right

542 Occasional Notes of the Quarter. [Jan.,

from wrong ; but even they were not unanimous ; and such was not always
the ruling of Hale, or Kenyon, or Erskine. " The execution of a madmanf"
says the great Coke, *' would be a miserable spectacle." And so late as
1832 we find Baron Gurney in the case of a lunatic homicide, charging the
jury that they were sworn to try whether the prisoner be insane by the visi-
tation of God, or whether of'deceit or covin he counterfeits insanity."

It is not much to ask that in such a case, as that of Bordier, scientific
examination of his mental condition be instituted. If found insane, surely
he will not be sent to die in his sin ; time may restore his reason, give him
opportunity for the earnest prayer, for the deep and real repentance of a
healthy mind. The humanity of the old English law would not allow the
capital punishment of a crimmal who even became insane after condemna-
tion ; because, ** peradventure," had he been of sound memory, he might
allege something in stay of judgment or execution." Are we less humane
in the present day ? While more than a doubt remains as to the sanity of
Bordier, can we send him to the scaffold ? The dispensation under which
he suffers is more terrible than any that human vengeance can inflict upon
him. If the present law of England now justifies the hanging of a lunatic,
let iiuch law be altered, as being contrary to the teaching of science, to the
promptings of humanity, and to the dictates of common sense.

I am, sir, your obedient servant,

Harrington Tukr.

We sympathise lieartily with the earnest condemnation of the legal
criterion of responsibility contained in these letters. No one who has
any practical knowledge of insanity can do otherwise. What we fail
to perceive in them is any real bearing on the particular question
of Bordier's insanity, apart from the expression of the individnal
belief ; and most of what they contain might be admitted without
the case being thereby carried one step further. Mr. Gibson, the
surgeon of Newgate, wrote a letter to the 'Lancet,' contradicting the
description of his testimony by Dr. Tuke as negative, and stating
that he had examined Bordier very fully on the subject of the
murder, while he was under his care, and had not perceived any indi-
cation of insanity in him. Dr. Tuke again assumes that Mr. Simp-
son had discovered distinct delusion in Bordier's mind, but does not
specify what the delusion was. Apparently, however, Mr. Simpson
had persuaded himself that Bordier conmiitted the crime under the
influence of a delusion that ''it was necessary he should die,''
although the supposition is not consistent with Bordier's own explana-
tion of the motives which instigated him, as these are set forth in
his letters. We are inclined to agree with Mr. Justice Smith, that
it was questionable whether it was a delusion, and that the
assumption of it as such " was one to be regarded with great caution.*'
Equally untenable appears to us the supposition that Bordier be-
lieved in an actual pillar or barrier of blood standing up between the
knife and his own throat, and preventing him from cutting it;
the real explanation being the very natural one, that, using
Mr. Justice Smith's words, "when he saw the blood as it
flowed from the throat of the murdered woman, he became

1868.] Occasional Notes of tie Quarter. 543

frightened, and his imagination staggered/' What more natural
in a sane person, what more unlikely in an insane person under
the circumstances ? But even if this were not a figurative expres-
sion, but a delusion, it was a delusion subsequent to the murder.
And if the prisoner was so insane as to have a delusion of that ex-
treme kind, it is hard to believe that the two medical men who had
daily opportunities of seeing him after the murder, and one of whom
particularly examined him concerning it, would have failed to per-
ceive any indications whatever of insanity. Every one must admit
it to be most necessary to view with extreme caution any attempt to
obtain the acquittal of a murderer on the ground of insanity when
there is no evidence furnished of mental unsoundness before or after
the crime, when, in fact, the crime itself is the only evidence afforded.
It is little use, however, arguing about a case of this kind on entirely
theoretical grounds, and we shall content ourselves, therefore, by
printing here two more extracts from the 'Medical Times and
Gazette,' which ended the discussion on Bordier's case."^ The first
is a letter which appeared on November 9th, and the second is a
leading article of the week following.

Sib, — Sympathising in the main with what seem to me the sound and sensi-
ble observations on the trial of Bordier which have appeared in the " Medical
Times and Gazette, I cannot forbear expressing my entire concurrence with
your view of this unhappy case. It was not without surprise mingled with
regret, that I read the letters which Dr. Laycock and Mr. Wood, whose
opmions cannot fail to carry weight in such a case, addressed to you : sur-
prise, because the evidence furnished of Bordier's insanity at the trial was so
weak, suspicious, and self-contradictory that it seemed impossible it should
produce conviction in the minds of those who had practical knowledge of
insanity ; regret, because the attempt to obtain the acquittal of a murderer
as insane on such trivial grounds must inevitably increase the popular sus-
picion of the plea of insanity, and prejudice the cause of those criminals who
are really insane. There can be no question that the law affecting offenders
against it who are suspected to be of unsound mind, and who are put upon
their trial, is unsatisfactory, and ought to be repealed ; but if one thing has
wrought more than another to prevent the modification of the law in accord-
ance with scientific principles, it is the painful distrust excited in the public
mind by the unwise attempts made to rescue from justice, on the ground of
insanity, criminals whose main or only title to such a plea has been the enor-
mity of their crime. The plea of insanity has become the lawyer's last re-
source in a desperate case; and the public has persuaded itself that a mad-
doctor can always be found to support the most forlorn case. Bordier's trial
is not likely to weaken that conviction.

The circumstances of his crime, which will be fresh in the recollection of
your readers, were of no uncommon character. He had quarrelled with his
paramour ; she bad resolved to leave him ; he was irritated, depressed, and
wretched ; and he determined, rather than bear the misery of the desertion,
to cut her throat, the throats of his children, and his own throat. Had he

* Though correct when it was written, this statement is not so now ; for while
this sheet was in the press, Dr. Laycock published another long letter in the
" Medical Times.'

544 Ocetuimal Notet of the Quarter, [Jan.^

been an Englishman, he would probably have carried his resolve into execu-
tion without writing a letter to declare ' his intention and to explain his mo-
tives. But some amount of theatrical display is congenial to the nature of
Frenchman. If two lovers in Paris agreee to commit suicide together by
suffbcatiDg themselves with the fumes of burning charcoal, the chances are
that thej leave on the table, or send to their friends, a written de-
claration of their misery and of the reasons which moved them to end it.
It argues the vanity of a weak character in those who thus insist on taking
the world into their confidence, and imagine it will be interested in their
confessions, but it is not sufficient evidence of insanity. No wonder, then,
that Bordier failed to go through with his project, and that, frightened from
his purpose by the first sight of blood, he cot no further than the first act of
the tragedy. Had he been really insane, it may well be doubted whether he
would have thus faltered at the outset of his frenzy. What more natural in
a sane person, what more unlikely in a madman, under the circumstances?

Mr. Simpson's evidence of the prisoner's statements and conduct immediately
after the crime should obviously be received with extreme caution. His nunner
of searching for and discovering indications of insanity at his short interview
was most objectionable, and it is impossible to resist the conviction that the
questions were put in accordance with a theory preformed — perhaps uncon-
sciously— in the mind, and so put as unavoidably to elicit support of it. The
existence of this strong bias in his mind, leading captive his understanding,
afibrds the only possible explanation or excuse of the assertion that Bordier
did not know the le^al quality of his act, did not know that he was doing
wrong, in face of the positive evidence to the contrary, manifest in what
he wrote immediately before and what he said immediately after the crime.
Making no undue allowance for this evident bias, I certainly fail to perceive
in Louis Bordier's condition, as described by Mr. Simpson, or in the combi-
nation of circumstances which he marshalled in favour of his theory, anything
inconsistent with sanity, or with that degree of sanity which a murderer
may be allowed to possess. All the circumstances pointed to one conclusion
— toe conclusion adopted by the jury, endorsed by the judge, and vindicated
by the law. That Bordier was rendered irresponsible by reason of mental
disease seems to me a proposition only a shade less violently improbable than
the assertion that he did not know he was doing wrong when he cut his para-
mour's throat.

But Bordier had suffered from an anal fistula, and had been depressed in
mind and body by his disease. It is true that, as Dr. Laycock and Dr. Wood
have pointed out, a fistula will sometimes produce despondency ; it is also
true that a murder may be a madman's act ; but the majority of those who
sufier from 6stula are not insane, and the majority of murders are not perpe-
trated by madmen. I should hardly understand Dr. Laycock and Dr. Wood
to argue that all who are afilicted with fistula are necessarily despondent and
on or over the border of suicidal mania, or that the despondency undoubtedly
produced by fistula in some cases always amounts to insanity. And yet^ if they
do not mean that, their letters, apart from the expression of individual convic-
tion, have no bearing on the particular question of Bordier's insanity, but leave
it exactly where it was ; they contain certain generalities that may be true ab-
stractedly, but no applied reasons to warrant the belief of Bordier's mental de-
rangement, nor any argument of it drawn from an analysis of the evidence given
at the trial. Now, in order to prove insanity, or even to raise the suspicion
of it, in a particular case, something more is assuredly needed than the exis-
tence of a fistula or the perpetration of a murder. And where is this to be
found in Bordier's case r Not a word was said at the trial of any manifes-
tation of madness by him before the murder. Either such evidence was not
forthcoming, or his counsel deemed it of such an unsatisfactory character as

1 868.] Occasional Notes of the Quarter. 545

would injure rather than help the defence, and wisely refrained from calling
it. The surgeon of Horsemonger Lane Gaol and the surgeon of Newgate,
both of whom examined the prisoner for a time ailer his trial, saw no indica-
tion whatever of insanity in him. It is impossible to pass by as of no account
this direct and positive scientific testimony founded on ample personal obser-
vation. There remains, then, only the crime itself, together with the circum-
stances of its perpetration, and the murderer's behaviour immediately
afterwards.
Undoubtedly there is much room for difference of opinion as to the inter-

Eretation of what a man says or does just after he has committed a murder ;
ut every one will admit it to be most necessary to view with great caution
and jealousy any attempt to obtain the acquittal of a murderer on the ground
of insanity when there is no evidence procurable of mental unsoundness be-
fore or after the crime — ^when, in fact, the crime itself is the only evidence
offered. I trust that the English law will continue to look with extreme
suspicion on the madness which, like Jonah's gourd, comes up in the night
and vanishes in the morning.

I fear sir, that you may think I have already trespassed unreasonably
on your space, but I cannot help adding a few words in illustration of the
mischievous conseq^uences whicn flow from the medical theories hastily put
forward in cases like that of Bordier. On the occasion of the discussion
which took place in the House of Commons on Townley's case, I remember
hearing a rather violent speech condemning the commutation which had been
made of his sentence ; and the speech was loudly cheered. In the course of
this speech the honourable member quoted a document in which it was stated
on official authority that during seven years, from 1852 to 1858, seventy-
nine patients were received into Bethlem Hospital who had been acquitted
of murder or of attempts to murder on the ground of insanity, and that
in several cases no symptom of insanity whatever was manifest dur-
ing their residence in the hospital. This statement was brought for-
ward as convincing evidence of the mischievous character of medical
theories regarding insanity, and as constituting a fatal objection to the
establishment of a medical .commission, or of medical assessors, to aid in
ascertaining the state of a prisoner's mind when the defence of insanity was
set up. The speaker was Mr. Gathorne Hardy, now Home Secretary. I do
not sympathise with hb conclusions, but it is hard to be surprised at them.

I am, &c.,

Hbnbit MaUDSIiET.

The leading article which follows has evidently been written by

some one having an exact knowledge of the facts of the case. It is

perhaps a pity that any one not so qualified to judge ever wrote a

word about it.

Thb Sanitt of Bobdieb. — Our readers must be nearly tired of this sub-
ject. Week after week it has been discussed in our columns. We have had
letters from Professor Laycock, embodying with characteristic frankness,
and expressing with characteristic energy, Professor Laycock's well-known
opinions ; from Dr. Wood, a physician who has acquired a right to be heard
on such matters ; and from one of the most successful investigators and
highest authorities in the department of mental disease. Dr. Maudsley. But
it IS time the war of words should cease, and we shall, therefore, attempt to
sum up the case as concisely as we can, making what conmient we think
necessary as we proceed. To the system of scientific advocacy we are alto-

§ ether opposed. A medical man ought always be impartial. It is true that
ifferences of opinion may arise, and doubtless will arise, but for all that the
sight of two men, each eminent in his own way, swearing completely contrary

546 Occasional Notes of the Quarter. [Jan.^

to each other — merely, it may be, from the accident of having been retfuned
bv a certain party — is far from edifying. Fortunately, the case of Bordier
did not present this disgraceful spectacle, and the dirty linen of the profes-
sion has this time been washed in comparative privacy; still, the differences
of opinion which have been elicited in our columns would, to a certain extent,
justify the doubtful confidence reposed by the public in those whom they
irreverently style ** mad-doctors."

We have all along held, and still hold to our o|)inion of the sanity of Bor-
dier at the time he committed the murder for which he suffered. Irrofessor
Laycock has treated us to a good many general * remarks on the subject of
insanity, and on the value of confessions by criminal lunatics, but he has
carefully avoided discussing the case of Bordier as a mere matter of clinical
history, if the term may be employed. Dr. Wood has also told us of a luna-
tic who had fistula in ano, but that, we submit, is wide of the mark. The
Question may be one of definition, for the evidence which satisfies Professor
laycock of the insanity of Bordier is very far from conveying to our mind an
impression similar to that we are accustomed, either in civil or criminal prac"
tice, to form of insanity — in other words, whom he calls insane we call sane. Let
us therefore examine the evidence brought forward in support of the theory
of Bordier's insanity — a thing which Professor Laycock and his fellow-
advocates have curiously avoided . This may be summed up as the deed
itself — for all atrocious murders are now-a-days received as proofs of insanity
— certain letters written by the prisoner, and the evidence of Mr. Simpson.
The first of these we shall simply pass over, leaving those gentlemen who
accept the theory of Bordier*s insanity to make the best or worst of it as
suits them. With regard to the letters, although repugnant to English no-
tions, they are such as have been written by scores of excitable foreigners
whom nobody would ever call insane ; and we would submit that, had not
the murder followed in their train, no one would ever have looked upon
them as more than the vague threats in which moody men delight to indulge.
As to Mr. Simpson*s evidence, he saw Bordier for half an hour just after he
had committed a most deliberate murder, which nevertheless had by his own
statement severely shaken his nerves, and examined him evidently with pre-
conceived notions as to his insanity — a proceeding in which we think Mr.
Simpson certainly erred. He never saw the man again until the trial, when
he came forward to bear testimony to the prisoner's insanity. No other wit-
nesses were called to do so — a fact which, seeing that the opinions of the two
gentlemen under whose observation Bordier had been since his arrest were
entirely adverse to this theory, conveys to our mind an impression of weak-
ness, to say the least of it.

If, again, we come to investigate the nature of Bordier's supposed insanity,
we encounter another difficulty; for, dealing with generalities, Professor
Laycock has carefully abstained fi'om telling us what form of insanity he sup-
poses the unfortunate man to have laboured under, beyond making use of
the vague term melancholia. He, however, would seem to draw some dis-
tinction between the state of Bordier's mind at the time the deed was com-
mitted, and its condition at a subsequent period when under observation.
Are we then to suppose that Professor Laycock holds to the belief of Bor-
dier's having acted under a sudden and uncontrollable impulse ? Surely he
cannot believe that this position is tenable when he reflects that Bordier had
brought the knife home from his work some time before, for the express pur-
pose to which it was applied, and put off the execution of his design until the
last moment. He was no epileptic maniac who, in a moment of frenzy,
wreaked his anger on whoever was nearest, and when he came to himself
knew nothing of what had happened. True, the man's spirits were depressed,
and the invulnerable authority of a lady, the matron of a Hospital for fistula,

1 868.3 Occasional Notes of the Quarter. 547

was invoked, to show that low spirits were characteristic of fistula. It is a
curious form of disease which contributes to high spirits, and we venture to
say that a man labouring under a good attack of dyspepsia will proclaim him-
self as miserable as any one could desire ; yet we could not hold him innocent
were he to cut his wife's throat. But perhaps we shall be told that low spirits
from fistula are the only kind which secure this desirable immunity.

In deciding whether a crime was committed under a sane or an insane im-
pulse, we were taught, when we went to school, to take the question of mo-
tive into consideration. Were we to do so in this case, the weight of evidence
would certainly tend towards the side of sanity. Again, the law says that the
evidence of insanity lies in delusions. We do not find any in this case, although
Mr. Simpson contrived to invoke a dummy for the occasion. It was no delu-
sion that the man was in very bad health, and terribly out of pocket ; that the
woman with whom he lived, tired of this state of affairs, was about, on the
very day the murder was committed, to leave him for a partner who was
better ofij and to abandon him with three helpless children on his hands.
We can see no delusion in all this, and many a man about whose sanity there
has never been a doubt has yielded to smaller temptation. But if there is
one thing more than another which has been overlooked in this discussion^
it is the simple facts of Bordier's case, partly because they were not completely
brought out in the report of the trial ; partly, perhaps, because the parties
to the discussion preferred vagueness to accuracy, generalities to particulars.
We shall tell the simple, but horrid, story of the murder of Mary Ann Snow,
and of Bordier's behaviour in the whole matter.

Bordier had long suffered from fistula, but during the whole period of his suf-
ferings he showed no tendency to hurt those who were near and dear to him —
no homicidal impulse. His disease got no better, but rather grew worse, and
he was forced to enter a hospital for the relief of his painful malady. While
Bordier was in hospital, Mary Ann Snow, who had got tired of the squalid
life of poverty she led with Bordier, now unable to keep her in the way she
had been accustomed to be kept, met another man, who promised better
things. It was accordingly arranged that she should leave Bordier to live
with this man, and of this Bordier was aware. According to the evidence
put in court, the two had quarrelled, or, at least, had words, about this very
man, and it was finally arranged that she should leave the unfortunate Bor-
dier the very day on the morning of which the murder took place. Bordier
could not bear to part with the woman, and to see the consequent misery of
the children ; so he resolved on putting all of them out of the world. To this
end he brought home the sharp knife already mentioned, but beyond that

Eoint he could not for a time proceed. He had determined on his course, but
e could not screw his courage to the sticking point — he even went one even-
ing and had four glasses of rum and water, that Dutch courage might enable him
to do the deed, but he could not. Finally, at the very last moment, when he
was about to leave for his work, in the day Mary Ann Snow had settled to
leave him, he determined to do it ; when he returned she would be no longer
there, and would be out of his power. He hesitated no longer, but cut her
throat. Even then he did not find it such easy work as he had fancied, the sight
of blood unnerved him, and he left her before she was dead. He next tried
to kill his child, but beyond putting his hand on her forehead, he could do
no more ; his heart failed him. Every one knows the rest. While in prison
no one in connection with him observed in him the slightest taint of insanity,
and he went to the scaffold, not rejoicing in death, but as a man who faces
the inevitable, who fears death, but walks calmly to the scaffold.

We appeal to all candid-minded men if in the above history there is any
trace of insane delusion. Do mad men require glasses of rum and water to
nerve them for an insane impulse, and after all fail in getting it up? If all

648 Occa9ional Notes of the Quarter. [Jan.^

murder be the result of insane impulse, this may be granted, but that, we
should fancy, few would be willing to concede. We have all along spoken
with a full knowledge of Bordier*s crime ; but our direct statements have
been met by a series of generalities. We here conclude the subject. Now
that we have again stated the plain unvarnished facts of the case, we leave
sensible men to judge for themselves. Our opinion has already been
given.

The Alton Murder.

The Alton murderer certainly did no credit to his art. His crime
was conceived without ingenuity, and executed in the coarsest man-
ner; the only remarkable features in it being its simplicity and
atrocity. On a fine afternoon a clerk in a solicitor's office takes a
walk outside the town; he sees some children playing in a field by
the roadside ; one of these, a lively little girl, between eight and
nine years of age, he persuades to go with him into an adjoining
hop-garden, and the others he gets rid of by giving them a few
halfpennies to go home. In a little while he is met walking home
alone, and he returns to his office, where he makes an entry in his
diary. But what has become of the little girl ? No one has seen
her since she was taken from her playfellows into the hop-field.
Her parents become alarmed ; they arouse their neighbours, and an
anxious search is made for the missing child. It is ascertained
that she was last seen on her way to the hop-field, and when the
searchers hurriedly proceed there, they find the dismembered frag-
ments of her body scattered here and there. A foot is in one place,
a hand in another, the heart and the eyes are picked up after a long
search ; and some parts of the body cannot be found at all. The
poor child had clearly been murdered, and her body cut into pieces ;
but what she underwent before she was butchered may be suspected
but cannot be discovered, because the ^' vagina was missing.*' Sus-
picion fell directiy^ upon the prisoner, and he was arrested. In his
desk was found a diary, and in the diary the following entry just
made : " Killed a little girl : it was fine and hot.'' Such are the
main facts, briefiy told, of the murder ; it is not surprising that
they excited horror and disgust in the pubhc mind, and that the
prisoner was denounced as a brutal and unnatural scoundrel, for whom,
if he were found guilty, hanging was too good.

Emancipating ourselves from the natural feeling of indignation,
let us look at the matter, however, from a purely scientific point of
view, in order to draw any lesson that may be procurable from it in
that light. In the first place, it is a libel on the beasts to call such
a crime brutal — ^brutes do not violate and murder one another in that
way; the crime is essentially and exclusively human. Men are
very ready to claim their superiority of virtue and intelligence over

1868.] Occasional NbUs of lie Quarter. 549

other animals ; let us not ignore our pre-eminence in vice also. In
the second place, to call such a crime unnatural is not to take it out
of the domain of natural law. That the murderer was a monstrosity
may be admitted, but monstrosities are not self-created, they must
have their necessary antecedents in the order of events ; not casualty
but causality governs them, the universe, and their appearance in it.
There is but one answer to^the question, so strikingly put by the en-
graver Blake in his little poem addressed to the tiger —

" Did He smile his work to see ?
Did He who made the lamb make thee ? **

To any one who has really studied the forms and laws of human
degeneracy, so far as these are known, the features of the Alton
murder could not fail to excite a suspicion, if not to beget a convic-
tion, that there was some taint of madness in the blood of the mur-
derer. He was plainly an instinctive criminal: the impulsive
character of the crime, the calm ferocity of it, the savage mutilation
of the victim, and the placid equanimity of the murderer immediately
after he had supped so full of horrors — all these indicate a bad
organization, a nature to which horrors were congenial, whose
affinities were devil ward. '^KUled a little girl; it was fine and
hot.'^ He puts down the fact as indiflferently as he might have done
if he had just bathed in the river instead of bathing his murderous
hands in a little girFs blood. It is not possible, we fear, to call
him actually insane, unless we are content to give up all exact
notions of what insanity is ; but there can be little doubt that, had
his life been prolonged, he would have become insane. The evi-
dence at the trial showed that a near relative of his father was in
confinement suffering from homicidal mania, and that his father had
had an attack of acute mania. Moreover, it was proved in evidence
by independent witnesses that he himself had been unlike other
people, that he had been prone to weep frequently .without evident
reason, that he had exhibited singular caprices of conduct, and that
it had been necessary to watch him from the fear that he might
commit suicide. These testimonies of an insane temperament were
not sufficient to stay the course of human justice; this falls on the
sinner often with indiscriminating force, taking no thought of
opportunities and of that worst of all tyrannies, the tyranny of a bad
organization. But it is not so above ; '' there the action lies in its true
nature;" and it may well be that many sorrowing murderers shall
come from the east and the west and find entrance into the kingdom
of the redeemed, when some who have, with exultant homicidal
yell, rejoiced over their fate on earth, are cast out into outer
darkness.

VOL. XIII. 'i^

550 Occasional Notes of the Quarter. [Jan.^

Cimlization in Southern Italy.

The follies and atrocities perpetrated in some parts of Southern
Italy, during the epidemic of cholera, by the panic-stricken popu-
lace, are a grim satire on the enlightenment of the age. Acting
under the ignorant belief that the cholera was propagated amongst
them by the authorities or other persons, who either poisoned the
wells or infected the air with some deadly poison, they violently
attacked and murdered those who became the unfortunate victims of
their frantic suspicions. At Ardore, a town in Calabria, on the
appearance of the cholera, the people assembled in arms before the
druggist^s shop, loudly declaring their intention to bum it to the
ground. An officer with a few soldiers in vain attempted to prevent
the execution of this design. The mob rushed madly forward,
trampled the unfortunate officer to death beneath their feet, set fire
to the shop, and ruthlessly butchered the druggist and his family.
Twenty other persons also fell victims to the ferocity of tlie enraged
multitude. Similar tumults occurred in other places. At Potentino
the mob surrounded the house of a certain Antonio Sabellino, with
whom resided his brother Francesco, and a friend, Giacomo di
Mattia, accusing them of being poisoners. The rioters broke into
the house and searched for the alleged poison. At last they found
on a shelf a jar full of paste, which Sabellino kept for poisoning
rats. A dog having been made to swallow some of the paste died
in a few minutes. This was thought conclusive, and the mob
rushed upon the two brothers and their friend and brutally mur-
dered them. In the parish of Cogliano it was firmly believed that
the poisoners went from door to door and blew the infection through
the keyhole. Accordingly a great number of the lower class of
people abandoned their houses and camped out in the open air, so
that they shouldnot be poisoned ; while those who remained at home
were constantly firing muskets out of their windows with the idea of
paralysing the action of the poison. The authorities and the troops
only succeeded after immense efforts in convincing the people of
their folly.

Scenes like these cany us back to the middle ages, when the
frenzied terror produced by the. ravages of the plague or " black
death,^^ as it was called, led to the horrible persecution of the Jews,
who were accused of poisoning the weUs. Innocence availed
nothing before the popular frenzy, and where confessions of crime
never committed were extorted by excruciating torture. In Basle
all the Jews were inclosed in a wooden building, constructed for the
purpose, and burnt together with it, without sentence or trial. In
Ma/ence alone 12,000 Jews are said to have been put to a cruel

1868.] Occasional Notes of Ike Quarter. 551

death. At Eslingen the whole Jewish community buraed them-
selves in their synagogue, to escape a worst fate. Everywhere they
were pursued with merciless cruelty, and either fell victims indis-
criminately to the fury of the'^populace or were tortured into con-
fessions of impossible crimes, ana then sentenced to be flayed or
burnt alive.

Do we need the experience of the horrible events which have
lately followed the devastations of cholera in Italy, to warn us that
we are not yet secure from similar epidemics of popular madness ?
They spring from an ignorance of the laws of nature, and are
inspired by the terror which is bred of ignorance. And how little
do the people, generally, yet know of the laws of health, and of the
penalties which avenge their infraction ? It is not likely, perhaps,
that they will ever in this country attribute the outbreak of a pesti-
lence to a deliberate poisoning of the wells by the Fenians, or any
other body of persons to whom they may chance to have a specially
hostile feeling ; but it can hardly be considered impossible, so long
ias epidemics which arise ^'entirely from a gross ignorance and neglect
of sanitary laws are attributed to the specid act of Providence,
and so long as prayers are specially put up for the miraculous
removal of them, instead of for the gift of a right spirit to learn
their nature, and manfully to strive to get rid of them. Surely a
generation which acts' in this way, which follows after " Davenport
Brothers,^^ and has a "Zouave Jacob'' for its prophet, cannot afford
to feel too safe from an epidemic of frenzied terror like that which
has afflicted the mob of Italy. Within a few days of the accounts
of the atrocities perpetrated in Calabria, the following paragraph
appeared in the 'Cork Examiner' : —

A riot, originating in an extraordinary superstition, occurred at Myross,
in the west of this county, a few days ago. A body, supposed to be that of
the captain of an American ship lost on the western coast, was washed ashore
near Mjross some time since, and, after an inquest had been held, was
interred in Myross churchyard. Friends of the drowned sailor came
recently to Myross to claim the remains, and to carry them back to the
United States for interment in the burial ground where others of the
deceased*s family rested. When it became known that the body was to be
removed, there was great perturbation amongst the country people, who
have a superstitious belief that the exhumation of a corpse that has been
buried for some time causes unusually great mortality during the ensuing
twelve months — one of those extraordinary notions deep-rooted in the
popular mind which defy human ingenuity to analyse or explain. To
prevent the threatened calamity, the country people resolved to oppose the
removal by force. On the morning on which the exhumation was to take
place the population of the district, armed with the miscellaneous weapons
that the farmyard affords, arose en masse against the strangers, and drove
them and their assistants out of the graveyard. The parish priest was
appealed to, and strove to reason the people out of their absurd apprehen-
sions; but his influence, all-powerful m everything else, failed to make an
impression on their superstitious fears. The people still refuse to permit the

552 'Occanonai Notes of the Quarter. [Jan.^

i>ody to be removed, and mount guard day and night over the grave. The
friends of the deceased are determined not to allow their pious mission to be
frustrated by a popular superstition, and it is stated that the aid of
the military will be called in if other influences cannot induce the people to
desist from their cruel and insensate opposition to the removal of the body.

Wliile the state of popular education in this country is such as to
permit the existence of superstitions of this kind, it is evident that
there will be no lack of work to engage the energies of a reformed
Parliament. Even those who think fearfully of the late political
* leap in the dark^ may take comfort from the reflection ^that no
system of government can well leave the people in a blacker ignor-
ance of natural laws than they are in now, after some thousands of
years of government by their betters.

Insane Negroes in the United States.

The annual report of the Superintendent of Longview Asylum, in
the State of Ohio, contains a striking illustration of the deep-rooted
repulsion which is felt to a black skin in the United States. A very
heavy item in the yearns expenditure has been caused by the purchase
and fitting up of a house for the coloured insane, who had hitherto,
as appears, been confined in the common jail. The superintendent
expresses his gratification at the provision of accommodation more in
accordance with the dictates of justice and humanity. '* Two of
the greatest misfortunes that humanity is liable to — ^insanity and a
coloured skin — did not seem to me good and sufficient reason for
classing the person so afflicted with malefactors, and it is therefore
a matter of sincere rejoicing that a change in the disposition of these
persons has been made, and especially that Hamilton County has
taken the lead in this matter.^' After the passage of a law enforcing
suitable provision for the coloured insane, application was made for
their reception into the building occupied by the whites. This was
thought out of the question by the authorities of the asylum, the
strong prejudice against the negro felt by most white people being
particularly strong among the imnates of the asylum. It became
necessary, therefore, in order to carry out the intention of the legis-
lature, to purchase a separate building, and to fit it up specially for
the coloured insane. This was done ; and the medical superintendent
can now point with pride to the circumstance that all the insane
negroes belonging to the county are freely received and kindly
treated.

Whatever may be thought of this plan of procedure by the
enthusiastic philanthropists, who, in spite of nature's brand of
inferiority, would at once raise the negro to an equality with the
white in every respect, we cannot help feeling that it was the only

1868.] Occasional Notes of the Quarter* &5S

practicable course for the present in a country in which the two
greatest misfortunes of humanity are deemed to be insanity and a
coloured skin. The utterance of such a sentiment by a physician
who has been energetic in advocating the adoption of a humane
provision for the coloured insane is the strongest proof how much
deeper than philanthropy can yet fathom lies the instinctive repul-
sion of the stronger race to the weaker race, which it has so
long wickedly held in a harsh bondage. Events march very
rapidly in this age, and especially so in the States of America, yet
we may rest well assured that it will not be in this day or generation
that the white and the black man can meet as brothers, having com-
mon sympathies and equal rights.

Psyckological Intuition.

Can any of our readers give us some information concerning the
new art of discovering the soul^s destination by an inspection of the
face of the dead ? A communication from Eome, in the ' Univers,'
speaks in these terms of a young captain of the Pontifical Zouaves,
killed in the battle of Mentana : — " A most gracious smile was stiU
on his lips ; and, strange contrast, which depicts the difference of the
two causes, by the side of this noble young man lay the corpse of a
Garibaldian with a red beard, covered with blood, and whose face
expressed damnation.^' Pearfiil and wonderful fact ! A foretaste
of the inexpressible joys of heaven had blessed the last moments and
illuminated the countenance of the youthful captain slain in the^
holy cause; a forefeeling of the tortures of hell had stamped its
terrible agony on the face of the Garibaldian slain in the unholy
cause of freedom ! Scientifically, we cannot but lament that the
correspondent gifted with such miraculous insight did not commu-
nicate more particularly the characteristic appearances of the face of
the corpse, which disclosed to him the salvation or damnation of the
soul that had animated it. Perhaps he might be able to teach us
how to discover in the lineaments of the countenance of Napoleon
in the disguised features of a heavenly archangel, and in the face
of Garibaldi the concealed features of a special minister of Satan, if
not of the archdemon himself. At any rate, we may express a hope
that, for the future, one who is gifted with this supernatural intui-
tion will limit his investigations to the living, " an^ let poor damned
bodies be.'^

664 Occasional Nates of ike Quarter. [Jan.,

The CarmarlAen Matron,

At the Carmarthen Borough Police-court, on Monday, 26th August
last, before the Mayor (E. B. Jones, Esq.), J. Bagnall, Esq., and
Dr. Lewis, Miss E. H. Lewis, the matron of the Joint Counties
Lunatic Asylum, situate near Carmarthen, appeared in answer to a
summons charging her with having unlawfully assaulted, on 1st of
August last, a lunatic patient confined in that asylum.

The particulars of this case as they ap})ear in the ' Carmarthen
Journal are of a very painful nature. It is hardly conceivable that
such a thing could possibly have occurred in the present day in one
of our much and justly lauded public asylums ; and it is certainly
unique in the records of lunacy for the last twenty years. It cannot
be wondered at if ordinary attendants, ill-educated and often men
who have failed in life in other respects, do occasionally, under the
great provocations to which they are subjected, so far forget them-
selves as to strike or abuse a patient entrusted to their charge ; but
that one of the chief officers of a county asylum, who had previously
held an appointment in one of our most modern and best English
county asylums, could so far forget all sense of decency and humanity
as to allow four nurses to hold a patient down whilst she proceeded
to chastise her with a stick a yard long, procured from a neighbour-
ing hedge for the purpose, is indeed incomprehensible, and most
mortifying to all disciples of the gentle teachings of ConoUy and
Pinel.

The facts of this case, as given in evidence by the medical superin-
tendent, the assistant medical officer, and four nurses, appear to be
much as follow : — On the 1st of August last two patients, named
Jones and Bowers, began quarrelling, and on a nurse going to inter-
fere Bowers struck her ; Miss Lewis then came up, and on Bowers
trying to strike her she ordered the nurses to take her to bed.
Bowers then became very violent, and it required four nurses besides
Miss Lewis to undress her. Bowers had hold of Miss Lewis during
the scene, and Miss Lewis struck her twice, in self-defence one nurse
says, and in struggling to get from Bower's grasp her jacket was
torn. " After Bowers was in bed Miss Lewis struck her several
times with her fist on the chest ; she then went out, brought back a
bunch of keys, and knocked Bowers with them across the thighs
until blood came. Then she went out again, brought in with her a,
stick out of the hedge, and about the size of a walking-stick, and
beat Bowers with it across her thighs, legs, and back.'' When they
were about to leave the room poor Bowers sat up in bed and asked
Miss Lewis to give her a kiss. But instead of doing so, it was said
that she turned back^ kicked the patient twice in her stomachj spat

1868.] Occasional Notes of the Quarter, 556

in her face, and called her a nasty old brute. On the 4th of August
one of the nurses reported this circumstance to the medical superin-
tendent, Mr. Wilton, who immediately examined Bowers, and '* found
that she was extensively bruised on the front and back part of both
thighs, that there was a slight bruise on each calf, a slight mark
across the lower part of the loins, and a bruise on the lower part
of the chest, but that was a very slight one.'* The above facts were
sworn to positively by the four nurses, and the counsel for Miss
Lewis did not venture, apparently, to cross-examine them.

T^or the defence Miss Lewis's counsel said — " I have been in-
structed by Miss Lewis to plead guilty of haviag assaulted that un-
fortunate woman. Miss Bowers, and at the same time to say that she
is exceedingly sorry that anything of this kind has happened. How-
ever, as you have seen by the evidence, there was a cause of provo-
cation, and Miss Lewis lost her temper. She cannot farther account
for it, and very much regrets her fault. But whilst admitting so
much. Miss Lewis yet denies that she spat in the woman's face, or
kicked her, or called her a nasty brute. She has, however, now put
herself into this sad difficulty, and I can only leave the case in your
hands, hoping that you will deal with her as leniently as possible.''

In answer to the bench, Mr. Hughes, the clerk to the magistrates,
stated that Miss Lewis had been suspended from her duties and
•would be dismissed from her post. The mayor, addressing Miss
Lewis, then told her the magistrates had concluded to fine her £10
and costs, with the alternative of three months' imprisonment.

It was thus clearly proved, even by Miss Lewis's own confession,
that she was guilty of an assault on a lunatic with a stick, and we
were hardly prepared, therefore, to find the clerk to the visitors, who
appeared to prosecute on their behalf, endeavouring, during the
inquiry, to excuse Miss Lewis's conduct and to obtain a mitigation
of her sentence by expatiating on her great sorrow and contrition for
what she had done, and the excellent testimonial she brought with
her from the Cambridge Asylum. Such conduct as she had been
guilty of surely deserved severe punishment; she was the senior
female officer, had had considerable experience in the proper treat-
ment of the insane, and was, it may be presumed, a person of educa-
tion. Had the oflfender been a poor, rough, uneducated country
girl, there would have been more reason for showing mercy. But,
perhaps, the most surprising part of the affair was the fact that.four
women could be found in the limited sphere of a small lunatic asylum,
so lost to all sense of common fairplay, as to be willing, not only to
witness, but even partially to assist at such a disgraceful scene with-
out interfering, or reporting the subject until four days afterwards.

£56 Oecasianal Notes ofihe Quarter. [Jan;,

TAe Irish District Asylums for the Insane*

{From a Corretpondeni.)

We have before us an Act of Parliament, passed at the close of
the late session, in connection with our sister institutions for the
insane in Ireland, the provisions of which, being of more or less
importance to our more distant brethren, we are desirous of analysing
as fully as pressure upon our space will permit.

This Act bears the date of the 20th of August, 1867, and is en-
tituled '^ An Act to provide for the appointment of the OflScers and
Servants of District Lunatic Asylums in Ireland, and to alter and
•amend the Law relating to the Custody of dangerous Lunatics and
dangerous Idiots in Ireland/'

It consists of eleven sections, which are succinctly as foUow :

1. The word officer shall include resident medical superintendent, con-
sulting and visiting physician, chaplains, matron, apothecary, clerk, and
storekeeper, schoolmaster and schoolmistress, and any person discharging any
duties in any such asylum whom the Lord-Lieutenant, by order in Council,
shall so designate.

2. The Lord-Lieutenant, from time to time, by order in Council, shall
determine the staff of male and female officers and servants, and direct the
Bame being increased, diminished, or altered, and appoint their salaries, and
define theur duties, and make rules and regulations for their control and
guidance.

3. The Lord-Lieutenant to appoint the resident medical superintendent,
who must be qualified to practise both medicine and surgery, and registered
as such under the Medical Act, 1858. All other officers to be appointed by
the governors of the district asylums, with the approval of the Lord-
Lieutenant. The servants to be appointed by the governors.

4. All appointments of officers by the governors to be probationary only,
and confirmed by them not sooner than three, nor later than six, months
from the date of the probationary appointment ; and every appointment so
confirmed to be submitted for the approval of the Lord-Lieutenant ; and
should the governors not, within six months, confirm such probationary ap-
pointments, or refuse to do so, or should the Lord-Lieutenant refuse
to approve of any appointment so confirmed, and notify such refusal to the
governors, the officer so appointed shall cease to hold office, and the same
shall become vacant at the end of six mouths.

5. The Lord-Lieutenant to appoint officers in default of governors not
doing so at the end of two months after they have been required to do so,
in writing, by one of the inspectors of asylums.

6. The resident medical superintendent to hold office durins the pleasure
of Lord-Lieutenant ; removal of all other officers to be by the governors,
with the approbation of the Lord-Lieutenant. The governors to dismiss the
servants.

7. All appointments inade by the Lord-Lieutenant before the passing of
the Act to be valid and efiectuid.

8. "From and after the passing of this Act it shall be lawful for the
governors of any district lunatic asylum, with the approval ofthe inspectors of

1868.] Oecamnai Notes of the Quarter, 557

lunatics, or one of them, on the retirement of any officer or servant whose
whole time has been devoted to the service of such asylum, to direct that anv
officer or servant shall receive such superannuation allowances as they shall
think proper ; and in ascertaining and awarding the amount of such super-
annuation allowance, the said governors shaS proceed according to the
principles laid down by the * Superannuation Act, 1859/ and every such
superannuation allowance shall be advanced, paid, presented for, and raised
in like manner as any other moneys advanced or raised for supporting and
maintaining such district lunatic asylum: provided always that nothing
herein contamed shall prejudice or affect the right to superannuation of any
person employed in any district lunatic asylum previous to the passing of
this Act."

9, 10, 11. These sections direct the ceasing, from and after the Ist of
January, 1868, of '* dangerous lunatics or dangerous idiots" being committed
to any gaol in Ireland, as hitherto, who, instead thereof, are to be sent to
'' the lunatic asylum established for the county in which they shall have been
apprehended," under the warrant of two justices of the peace, on their
being proved, by the certificate of the medical officer of the dispensary dis-
trict— for which certificate he is to get '* neither fee nor reward" — ^to be ** dan-
gerous lunatics or idiots.**

The above is the substance of an Act dealing with most important
matters in the government and economy of establishments above all
others requiring the gravest deliberation in every step that is taken
in their management.

It will be recollected by our readers that some years ago there
was a lengthened controversy between the Government of Ireland
and the Governors of the Belfast District Hospital for the Insane, in
regard to the appointment of a particular class of officers, viz.
that of chaplains ; and more recently with the Governors of the
District Insane Hospital of Cork, who, as regarded the Irish Execu-
tive, '^bearded the Uon in his den,'^ by disputing its authority to
nominate or appoint any officer or servant whatsoever, and by
absolutely refusing to acknowledge such appointments. The issue
with Belfast was a simple one and settled in due course of law
twelve years ago, on a writ of mandamus in the Queen^s Bench on
the part of the Irish Executive against the Belfast Governors, when
judgment was given that the former had no authority to appoint
chaplains; accordingly the appointments so made in the Belfast
establishment fell to the ground. Thus matters remained until the
present time, when the new phase occurred of the Cork governors
claiming the sole patronage of all appointments. The Government
took a short step — which has been fully efifected by this new Act
— to cut the Gordian knot and escape from their confessedly
embarrassing and undignified position. The Act, in its form
of a " bill,^^ was disposed of in its several stages with the utmost
despatch.

When the question formerly was mooted of appointing chaplains in
Belfast, we held the opinion that such appointments should be permis-
sive and not compulsory ; and most certainly we conceive that it is ex<^

558 OccMumal Notes of the (Quarter. [Jan.^

tremely arbitrary to force upon institutions the services of chaplain
functionaries in particular (wnich have hitherto been found the reverse
of beneficial^ and, at the best, of a questionable good), in oppo-
sition to local authorities whose deliberate judgment should be
respected in a matter of such importance. Virtually this new Act
of the TiCgislature places the entire control of the Irish district
asylums in the hands of the Executive Government, this having the
sole appointment of the chief officer, the medical superintendent, and
a vote in all the appointments of officers made by the local governors,
and an absolute power of appointment when the governors decline
exercising their patronage, besides the fixing of the amount of salaries
and the defining the duties of the entire staff of officers and servants
respectively.

but seeing the manner in which the governors of the Cork
District Asylum have been systematically acting, to judge by their
proceedings as regularly reported in the newspapers — a course
of procedure which would be so much " better in the breach than
the observance,^' and which is practised nowhere, happily, but
in their own district — ^we consider a step has been taken in the
right direction by the reins being taken out of hands so tmskil-
ful and offensive in management, and committed to executive re-
sponsibility, which cannot but be a less galling yoke than was
imposed under local assumption and arrogance. Indeed, it has fre-
quently amazed us to read in the newspapers the cQscourtesies
practised towards officials, who were treated as if they were mere
creatures of exacting boards, by those whose duty it should be rather
to sympathise with and support to the utmost gentlemen in their
onerous and ill-requited position.

Now that it has been authoritatively settled that the Lord-
Lieutenant of Ireland is to be unfettered in his selection of the
medical superintendents, in particular the chief officers of the dis-
trict asylum, and in appointing their salaries and defining their
duties, we most heartily congratulate our brethren in Ireland upon
this vast improvement in their status and independence, as we feel
satisfied that the Government will deal liberally and considerately
with them, and be careful to fix upon none for such responsible and
confidential posts of duty but those whose antecedents will afford the
strongest assurance of a faithful and efficient discharge of the trust
reposed in them. And here it occurs to state that the Government
have already given proof of their desire to obtain the right man in
the right place by adopting the same system as that pursued with
such good effect in filling vacancies as they arise in the Queen^s
colleges amongst the professors, by publicly announcing such
vacancies, and inviting candidates to send in their testimonials for
consideration. An announcement of this kind has appeared, since
the passing of this Act, for the appointment of th^ resident

1868.] Oceamnal Notes of the Quarter. 559

medical superintendents, namely, for the Auxiliary District Asylum
at Clonmel, rendered vacant by the very judicious and well-deserved
promotion of its former chief. Dr. Edmundson, to the Castlebar
establishment ; and for the district asylums at Ennis and Ennis-
corthy respectively, two new institutions now about to be opened for
the reception of patients.

It had not been dwelt upon that, in order to secure the best men in
every respect, and to make it worth their while to retain their impor-
tant charge, no cheese-paring economy, in fixing the salaries, or odious
restrictions on personal liberty — such as not being permitted to be
absent a single night without special leave ! — should be allowed to in-
terfere. " The labourer is worthy of his hire,'* and of all labourers
none is more deserving of a generous honorarium than a medical super-
intendent. We have it from the highest and most disinterested source,
that of Lord Shaftesbury, the chairman of the Metropolitan Commis-
sion in Lunacy, in his evidence before a select committee of the House
of Commons, viz., "I cannot think that any superintendent ought to
receive much less than from £500 to £600 a year, besides a house
and allowances/^ In Ireland, however, the average salary of the
resident medical superintendents of nineteen district asylums, with
an average number of patients of 300 nearljr, is under £350 per
annum,t which is entirely insuflBcient for his unceasing and most
onerous services — services which are much more arduous and con-
tinuous than either in England or Scotland, inasmuch as in Ireland
the resident medical superintendent is responsible for the entire civil
as well as the purely professional conduct of his institution, the
latter duty only devolving on his brethren elsewhere. More than
this certainly should not be imposed on superintendents whose
strictly professional duties are quite enough to occupy their time in
the care and treatment of their patients. This simply reasonable
view of the case was expressed in the report to Parliament of the
Royal Commissioners of Inquiry into the state of the Irish Asylums
inl858.t

We next come to the section of the Act in respect of super-
annuation, which has given just and grave cause of complaint and
disappointment. The superintendents had earnestly requested to be
removed from the " Civil Service Superannuation Act,*' a confessedly
ad interim arrangement at the time, and to be placed on the same foot-
ing in this respect as prevails in England and Scotland, namely, that
at the end of fifteen years' service, and not being under fifty years of
age, they should have a claim for a superannuation pension of two

* See ' Report from the Select Committee on Lunatics/ ordered by the Honse
of Commons to be printed, April 11, 1859.

t See ' Sixteenth ParlismientaTy Report of the Inspectors of Asylams in Ireland
for 1866/

'% ' Report of Commissioners/ p. 11.

560 Occasional Notes of tAe Quarter, [Jan,

thirds of their salaries and allowaaces, in the event of bodily oi
mental infirmity preventing the due discharge of their duties.
Though there was every reason to believe that this most reasonable
request would have been acquiesced in, yet at the eleventh hour, and
when it was too late to bring the influence of their parliamentary
friends to have this effected, our Irish brethren found that they
were continued on the " Civil Service Superannuation Act,'' which
requires a period of fifty years to be eligible for what the English
and Scotch asylum officials are after fifteen years' service. These
formerly had to be in office twenty years for this amount of retiring
pension, but the time was considered unreasonably long, on account
of the peculiarly harassing and anxious duties they had to dis-
charge ; accordingly, through the influence and zealous advocacy of
Lord Shaftesbury, m the House of Lords, the term of service was,
in 1859, reduced to fifteen years under the provisions of the 25th
and 26th Vict., c. iii, s. 12.

That distinguished authority, in his evidence already referred to,
when questioned before the select committee on the subject of the
superannuation of the medical superintendents and subordinates of
the public institutions for the insane as to limiting the right to
persons of fifty years of age to retiring allowances, thus jemphati-
cally expressed his views : — " No ; I think that would be very hard
indeed, and reference must be had to the peculiar nature of the
duties they have to perform. It is not like a banking-house, or in
a Government office, nor even is it like the toil they have to
undergo in military or naval service ; but the wear and tear upon
the nervous system of the medical superintendents and the attend-
ants is such that it may be considered almost a standing miracle
that so many of them can bear it for the whole twenty years before
they arrive at the period of superannuation."

It is quite true, no doubt, that the " Civil Service Superannuation
Act " allows a period of time not exceeding twenty years to be
added to the actual service of officers in public employments who are
required to be professionally educated ; but even if this maximum
of additional time of twenty years were given, the Irish superin-
tendents would still require twenty years' actual duty to be on an
equahty with their brethren elsewhere, and also to have attained
sixty years of age as a further qualification, whereas fifty years is all
that is required in respect of age with other superintendents. This
is certainly not " justice to Ireland," nor is it in accordance with the
recommendation contained in the report already referred to of the
Commissioners of Inquiry, in which it is stated ''that the law
should strictly provide for superannuation, and that the scale of retire-
ment in the case of the medical officers should not depend on the
same length of service as is required by the ' General Superannuation,
Act,' for the medical manager will usually have entered on the duties

1868.] Occasional Notes of the Quarter* 661

•of his oflSce after he has been some time engaged in the practice of
his profession/^ And again, as regards salary itself, the same com-
missioners observe " that the salary of the resident physician should
be such as will secure the services of a competent medical officer;
and we think it but just that it should increase with length of ser-
vice, so that those who fill the situation may not be shut out from
all prospect of bettering their condition/^

It should be mentioned, also, in justice to the highly popular
and eflBcient Government inspectors of asylums in Ireland, Doctors
Nugent and Hatchell, that they have frequently, in their able
official reports, directed the attention of the authorities to this
subject, observing that ''the resident medical superintendents in the
Irish district asylums, though fully on an equality in professional
status and acquirements with their brethren in England and Scot-
land, receive smaller salaries and less domestic allowances, though
at the same time they have more duties to perform, inasmuch
as on them the fiscal management of their respective institutions
mainly devolves/*

Another hardship complained of in Ireland is that the superannua-
tion section in the new Act is so framed that in the event of a
medical superintendent being advanced from one institution to
another, his previous service will count for nothing on a claim being
made for a retiring allowance, the wording being — "Any officer
or servant whose whole time has been devoted to the service of such
asylum/' Now, this is manifestly a hardship ; and the only way, in
fact, to remedy it, and to get rid of the difficulty which might arise
with boards objecting to be made accountable for the previous ser-
vice of translated superintendents (and with great force, it must be
admitted), would be for the superannuations to be charged directly
on the Consolidated Fund ; this we really conceive they should be
under any circumstances, as well as the salaries of the medical
superintendents, inasmuch as in all fairness the Government, who
appoints them, should be the paymaster — the parties exercising the
patronage having the best right to be so both morally and constitu-
tionally.

The change made in the existing law by this new Act, in reference
to the so-called '' dangerous lunatic** and '' dangerous idiot/*
appears an exceedingly rough and ready specimen of legisla-
tion. It is now provided that a warrant signed by two magis-
trates shall be sufficient authority for the placing of the above
directly in a district asylum, instead of sending them to a county
gaol in the first instance, as hitherto, and afterwards transferring
them to an asylum by an order of the Lord-Lieutenant, on its having
been previously ascertained that a vacancy existed. It is to be at once
gmnted that a gaol is a most unfit receptacle to which to consign a
fellow-creature labouring under insanity, and only a last resource,

562 Occasional Notes of the Quarter. [Jan.,

when the imperilling of life is in question^ either as regards the
patient^s own safety or that of others. The diflBculty, as matters
at present standi is, how can an asylum, already full to overflow-
ing as so many are, admit such inmates? This very pertinent
question was asked in the House of Commons, and to it no reply,
in point of fact, was given.

We must, before concluding these remarks, enter our strongest
protest, in this age of progress, against the continued use in legisla-
tive and ofBcial documents, as in the one now under consideration,
of such ignorant, unscientific, and offensive terms as ''lunatic
asylums,'* ''strict custody,*' and such like, as had recourse to, still to
designate institutions for the insane and the due care of their
inmates. It is high time that^they should be entirely exploded, and
a more correct and less odious nomenclature adopted. The example
should be set by the authorities, from the Legislature downwards ;
and we were well pleased to find that during the debate last session
in the House of Commons, on " MetropoUtan Asylums Poor Bill,'*
several members objected to " asylum** as a " most unfortunate
word;** suggesting that "hospital** should be substituted.

The practice of bringing " lunatic paupers*' — a most oflfensive
and " unfortunate** method of designating the insane poor — ^into
police-courts, to be certified for as the subjects of insanity, prior to
their removal to an " asylum,** is a vice in this Act which cannot be
too strongly denounced or animadverted upon ; it is only too well
calculated to brand one of the most deplorable of human afflictions as
a disease of degradation, as something akin to the lowest kind of crimi-
nality, and thus to make it and all connected with the unhappy " luna-
tic pauper** as of the " baser sort** in the eyes of their fellow-men.
We hope sooner or later to see these and similar plague spots of terms
"stamped out** of psychological literature, and committed to the
" tomb of all the Capulets,** Lord Shaftesbury, in his place in the
Legislature, could largely help towards the accomplishing of such a
desideratum.

The last remark we shall make is that the promoters of this Act
have shown a very illiberal and unjust spirit towards the dispensary
branch of the medical profession, by requiring at their hands certifi-
cates of insanity, "without fee or reward,** which has been an
additional inroad on, and uncalled-for interference with, the
legitimate rights of the profession at large.

1868.] 563

PART II.— REVIEWS.

Editorial Note. — In consequence of the pressure on our space,
we are compelled to omit the Beviews, and the excerpta from Asylum
Reports, We have in hand a ret?iew of Schwegler^s ^ Ham,dhooh of
Philosophy I and of some papers in the ^ St. Oeorg^s Hospital Reports ,
which we defer until April next.

PART llf.-QUARTERLY REPORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.

French Psychological Literature.

By John Sibbald, M.D. Edin., Medical Superintendent of the

District Asylum for Argyllsliire.

I. Annales Medico-psychologiques, vol. vii. and viii. for 1866. —
Contents : — "Buchez on the Nervous System and the connection be-
tween Mind and Body f M. Ott. '^ Medico-Legal Report on a Man
accused of Theft /' Achille Eoville. '' The Utility of Family Life in
the Treatment of Insanity f Brierre de Boismont. '^ Passion, Im-
morality, and Insanity/' Tissot. "Dementia Paralytica, as ob-
served in Cuba/' Munoz. "Medico-legal Inquiries relative to
Insanity -" Mittermaier and Dagonet. " On a Case of supposed
Insanity -" H. Bonnet. " On the Case of a Man who murdered his
Eather-in-Law /' Bourguet and V. Combes. " On a Case of In-
decent Conduct and attempted Rape *" V. Combes. " Pathology
of the Brain in Cholera /' Mosnet. " Medico-legal Reports on a
Case of Attempted Homicide ;'' LafBtte. " On a Case of Theft /'
V. Combes. " On the Causes of the Crowding of Asylums, and
their Remedies *" Berthier. " On Insanity, with Predominance of
Grandiose Delusions, and its Connection with General Paralysis /'

564 Report on the Progress [Jan.,

Baillarger. " The Connection between Constitutional and Diathetic
Diseases and the Neuroses, especially Insanity/* Ed. Dupouy.

Medico-legal Eeport on a Case of Murder )'' Brierre de Boismont.

Partnership with God : a Medico-legal Study/' Chatelain.
"History and Condition of the Asylum for the Insane in Cuba/'
J. Munoz. "The Connection between Pellagra and Insanity;"
Brierre de Boismont. " Anatomical Lesions in General Paralysis /'
Pranz Meschede. "Medico-legal Reports on a Case of Wilful
Incendiarism/' Teilleux. "On a Case of Simulated Insanity/'
Henry Bonnet and Jules Bulard.

Btichez on the Nervous System and the Connection between Mind
and Body, — ^The opinions of the late M. Buchez on physiological
and psychological subjects are reviewed by M. Ott, in a paper which
he read to the Societe M^dico-psychologique in November 1865.
The fundamental idea on which Buchez constructed his physiology
of the nervous system was broached by him first in 1824, and was
frequently reproduced by him in subsequent publications. He
•divided nervous phenomena into two classes, those of " impression-
ability" and those of *^ innervation." By the one term he de-
signated the faculty of receiving and of transmitting impressions,
ordinarily called sensibility and sensation ; and by the other, the
action of the nerves upon the non-nervous tissues, such as the
muscles. The capacity of the organs of the nervous system to pro-
duce these two kinds of phenomena he called "neurosity." This
word he chose in preference to those ordinarily used, such as nervous
fluid and similar terms, because, as he said, it indicates a faculty and
not a thing {nature) . But he none the less considers that it is a
material substance. This substance is produced and constantly re-
newed by the circulation; it is, on the other hand, destroyed by the
action of the nerves, the phenomena of impressionability and in-
nervation. All the organs of the nervous system he considered as
composed of nerve-fibres, which, in their ultimate analysis, consist of
hollow tubes, closed at intervals by diaphragms. The neurosity is
the fluid substance contained in these tubes. It is kept in motion
and passes through the diaphragms by a process analogous to en-
dosmose and exosmose. It diminishes in quantity, the nerve tube
becomes empty, the power of producing the phenomena of im-
pressibility and innervation ceases in proportion as these phenomena
are produced and as each part of the nervous system is in active
exercise ; but the loss is repaired by new material drawn from the
circulation. This diminution in quantity is always in exact relation
to both the intensity and locality of the functional action. M. Ott
enters into details in the development of the doctrine, which it is
unnecessary that we should notice ; but we may transcribe the ex*
planation he gives of what we call habit.

J868.] (f Psychological Medki7ie. 565

" It is a law of the living economy/' he says, ''that the exercise
of an organ so attracts to it the circulation that the nutrition, within
certain limits, more than repairs the loss ; and frequent use con-
sequently produces enlargement of the organ. The nervous system
is subject to the same law. From the development produced by
exercise, it results that the routes of the local circulation are in-
creased in volume and in number, and consequently the reproduction
of the neurosity becomes more abundant and more rapid. Tt
results also that the location or seat of the neurosity becomes more
capacious, and thus the nervous action itself becomes more prompt
and easy ; the repair becomes more rapid, and the neurosity accu-
mulates and produces a natural tendency to movement in the locality.
Hence we have the qualities characteristic of habit, increasing
facility to effect a movement in proportion to the frequency of repeat-
ing it, and the impulse to do again that which we have constantly
done previously. These observations are applicable to the im-
pressionability and the transmission of nervous movements, as well
as to the innervation. The tendencies produced by habit may,
besides, be transmitted hereditarily, and they constitute in those who
have received them, the 'aptitudes proper to certain races and
certain families/ "

We can only refer briefly to Buchez's psychological views.
He sets out with the dual nature of man : a spiritual part which is
the source of the unity manifested in our ideas, our aims, and our
actions, in short, in our whole life ; and a material organism which
is the instrument of our spiritual activity. Everything in human
action, which is subjected to the laws of succession and of plurality,
comes from the organism. The regular and successive order of our
thoughts and actions which constitutes human logic, in the largest
acceptation of tlie word, is the necessary consequence of the confor-
mation of the nervous system. liOgic, he says, is nothing but the
necessity imposed on all ideas, all sensations, and all actions, to sub-
mit to that kind of circulation through the different parts of the
nervous system whose number and special aptitudes are so appro-
priated to their nature, that every principle and every sensation
engenders inevitably its own conclusions. Every idea which is of
such a nature as to have an external realisation, passes, in order to
arrive at this result, through three successive conditions, depending
rigorously the one upon the other, their order being invariable. The
first condition is that of desire, the second that of reason, and the
third that of execution or practice. To each of these conditions there
are corresponding special nervous apparatus. With the condition
of desire are connected all the organic combinations from which feel-
ing results ; with that of reason, all the cerebral organization ; and
with execution, all the motor apparatus. The soul is defined by
Buchez as '' the substance of the human personality and spontaneity.'^ ,

VOL. xm. 89

566 JSqmw^ am ike Proffr€99 [Jan.^

He considered this substance as essentially one and active^ and re-
jected the opinion of those psychologists who attribute to the soul
a certain passivity^ or who represent it as composed of a m altitude
of different faculties. According to him the faculties of the soal
reduce themselves to a mere spontaneous activity^ which shows itself
IB acts of will or intelligence ; the inteUigence or the faculty of
eombining ideas and sensations^ and the memory^ that is^ the
power of preserving acquired knowledge. The other faculties of the
soul whicn have been admitted by psychologists^ are only results of
the connection between the soul and the organism.

The influence of the soul over the emotional apparatus is shown in
the inherent power which it possesses of exciting it, of spontaneously
bringing it into action ; and in the opposite faculty of circumscribing
its scope, and of arresting or regulating the emotional feeling as well
as the a|)petites and desires by which it is manifested. In his con-
ception of reason, Buchez did not admit the existence of innate ideas.
He considered those metaphysical abstractions which are always pre-
sent in the mind, and which are chiefly relied on for proving this
innate nature of ideas, such as the notions of cause, substance,
unity, &c., as being the '^ expression of the mere nature of our mind
and our organism, and as being necessarily produced from the moment
that these parts of our being enter into relation/^ As regards all
other ideas, and particularly those called moral, he attributed them
in the first place to education, but in part to sensation and in part to
reason.

In human society, it is by education that individuals receive in
infancy the first ideas which enable them to see and to think for
themselves. But it may be asked, how education can be possible
in the case of infants devoid of ideas of any kind ? Buchez con-
siders that the question may be solved thus : in consequence of his
first necessities and sufferings, the infant comes to conceive of the
fundamental difference between yes and no^ under the triple form of
command and obedience, activity and passivity, using and abstaining;
and these ideas give him the means of seizing and comprehending
all those which come to him by education.

As we have already hinted, Buchez regards memory as being both
mental and material. The material memory is that which enables
us to reproduce in the same order a series of impressions or signs, to
learn by heart pieces of composition of literature, and is evidently
connected with the sames causes as the association of ideas. It is,
indeed, the association of ideas in combination with habit. The
nervous connections between the impressions and the signs are in
most cases estabUshed in a stable manner only when repetition has
fixed them in the brain. In general, every reproduction of impres-
sions or of signs is an act of the material memory, and the greater or
lesser fkdlit; which, this a|jtitad6 exhibits^ is certainly comuMsted

1 868.] of Psychological Medicine. 567

with cerebral conditions. But the material memory does not come
into play except in the case of actual reproduction, of expressing
in thought or word a series of signs and ideas. Buchez carefully
distinguishes the mental memory from this. By the mental
memory we preserve in the mind the knowledge which we have
acquired. It is present there, however, though it may be
latent;' and the mind can call it up at pleasure whenever it
requires it. When, for example, we read a book, the pages, the
chapters which we have first read remain in our mind, although it
may be impossible to reproduce the material arrangement, the
expressions, or the forms. For if they did not remain there we could
understand neither the drift nor the conclusion of the work. In
like manner, when we have studied a science for many years, and in
subsequent years have completed our knowledge by practice and
experience, all these acquired ideas remain treasured in the mind,
although we seldom think of them, and it would almost always be a
great labour to unfold the course. But let a necessity for these
ideas arise, as in the case of a lawyer consulted by a client, or a
physician called to the bedside of a patient, and the knowledge stored
up in the mind comes forth to assist in the opinion which requires
to be formed. In other words, the material memory is the faculty
by which we recall anterior impressions ; the mental memory is
that by which we know that which we have learned.

Medico-Legal Beport on the Case of a Man accused of Theft. — M.
Achille Foville quotes the following from the ^ Constitutionnel^ of the
28th of August, 1865.

" On the 11th of August, 1865, the Court of Assizes at Lyons
had to try a man named Benoit Chuzeville, fifty-three years of age,
a labourer, residing at Saint Igny de Vers, accused of assassination.

" It appears from the indictment that a brother of the accused had
bequeathed to one of his nephews certain plots of land, but that instead
of recognizing the legality of this legacy, Chuzeville had persisted in
considering himself as the true proprietor of the ground, and
threatened with serious injury any who should attempt to remove
the crops. One M. Dumoulin having, however, become the owner
of these crops, repaired, along with his father, to the land in order
to commence mowing. Chuzeville met them, armed with a double-
barrelled gun and a pistol ready loaded. He killed the father, and
would have also killed the son had not the second barrel missed fire.
There then took place a hand to hand struggle, in which Chuzeville
tried in vain to use his pistol, but was disarmed and delivered over
to justice.

"In the course of the trial certain doubts arose as to the sound-
ness of the mental faculties of the accused. The policeman belong-
ing to' the parish, who was called as a witness, stated that six dayd

568. Report on the Progress [Jan.,

before the murder, Chuzeville, said to him, ' When you go to Men-
sols, go to the sergeant and tell him to come here with a policeman
to prevent the removal of the hay from my meadow, and if they do
not come ^ou may calculate on having to remove Dnmoulin, for I
will kill him if he takes my hay/

''Dr. Euel, who was examined as to the wounds which had
caused the death of Dumoulin, was also interrogated in regard to the
mental condition of the accused, and replied : ' That he could give
no definite opinion about it, but that he had heard it said that on
the occasion of his brother inheriting some property, Cliuzeville had
claimed a diamond of considerable value which should have been
found in the head of a serpent, and should have been diverted in the
succession. This referred to a period long ago.^ The sergeant of
police, having been interrogated on the same point, stated ' that he
did not regard the accused ns insane, but tliat he had heard many
say that he was not possessed of all his mental faculties.^

'' M. Villeneuve, for the defender, endeavoured to established by
the antecedents of liis client and by the declarations of the two la.<t
witnesses, that Chuzeville was governed by an exclusive passion, the
love of propertv, which, in his case, was a sort of monomania tliat
representee! to him, on all hands, enemies who desired to despoil him
of his goods, and that in this mental condition he could not be
absolutely responsible for his actions.

'' Found guilty, with extenuating circumstances. Chuzeville was
condemned to perpetual hard labour.'^

'' We have given verbatim,^' says M. Foville, '' all of the report
which bears upon the mental condition of the accused. These
elements are certainly very incomplete, very uncertain, and we are
far from considering the msanity of Chuzeville as an ascertained
fact, or even as very probable. But it seems allowable to me to
express regret that the study of his true mental state was not pushed
a little further; and, the moment a doubt on the subject was ex-
pressed, not only by the defender's counsel, but by two witnesses,
the one a physician and the other a sergeant of police, that a medico-
legal inquiry was not ordered. The results could not fail to throw
light on the obscurity of the case and to afford the jury a strong
element in coming to a decision.

'' This fact has struck us all the more forcibly, as we have bad
occasion very recently to observe a case which presented more than
one point of analogy to that which we have quoted. The man in
question has also for several years considered himself the legal
owner of property to which he has no valid right. It is true that
happily he has not been led to commit an act so lamentable as the
assassination of which we have given an account; but, starting
from the same conviction, he concludes with similar logic, that
be is entitled to gather in for bis own use the produce of the land.

186&.] of Psychological Medicine, 569

'* If the diflFerence is great from a criminal and social point of
view, it will at least be admitted, I think, that it has much less
importance from a psychological point of view, and that if in the
two cases analogous delusions are recognised as the starting-points,
the two acts, in spite of the different degree of regret with which
tiiey are regarded, will be recognised as being equally entitled to the
benefit of irresponsibility.

" However this may be, the person of whom we speak was
accused of stealing the crops, and was placed in the maison (Parrel
at Chalons-sur-Marne. During the examination doubts arose as to
the soundness of his intellect, and we were instructed, along with
Dr. Delacroix, jun., the medical officer of the prison, to report to
the authorities upon his mental condition.'^

Without following M. Foville through all the details of the report,
it may be stated that the man, whose name is Parjoit, had been
known from youth for his eccentricity, and at thirty years of age he
had an attack of acute mania, in consequence of which he was
placed in the asylum of the department. This illness was of short
duration, but his mind was left weaker than it had previously been.
He had difficulty in understanding that he must submit like others
to social obligations, and in particular could not be prevailed upon
to pay his debts. After the death of his parents their heritage was
divided between him and his two sisters. He agreed to purchase
their portions ; but after taking possession of them, he never thought
of paying. Recourse was had to legal means, and part of the pro-
perty was sold, but he would never give up his hold of the land.
In subsequent years he was frequently brought before the courts for
nonpayment of debt, and gradually his whole property was sold ;
but he never would acknowledge that it could be so, as he had never
given his authority for the sale ; and he regarded himself as treated
with great injustice when interfered with. The last time he came
into collision with the law was for removing the crops from the land
to which he had no longer the slightest claim ; but he maintained
that the land was still his. He admitted that the officers had fre-
quently brought papers to him ; but he did not understand why they
meddled with his affairs, and he paid no attention to papers or letters
on tiie subject. In talking of a fowling-piece which had been
seized at his house by the pohce several years ago, he said, ^' At the
fall of the republic a carbine was taken from me, and I was told
that it w^as at the tribunal at Chalons. I went there, and called the
procureur du roi, to whom I complained; but he refused to inter-
fere, as the police, he said, had done right. So the next day he was
dismissed from his post for having answered me improperly. Louis
PhilHppe was also dismissed on my account .''

The conclusion to which the reporters come is as follows: —
1. That Parjoit is really affected with insanity. 2. That, if in that

570 Report on the Progress [Jan.,

condition, he is conscious of the acts which he commits, he certainly
is not conscious of their moral value; and does not comprehend
the criminal character of those of which he is at present accused.
8. That consequently he cannot be regarded as legally responsible.
4. That there is too much reason to fear that if he were set at liberty
he would fall again into the same errors, and would commit acts of
violence against those who would oppose him, and whose rights he
is unable to understand ; that consequently he must be regarded as
a dangerous lunatic. (Dated 10th July, 1865.)

In consequence of this report, he was placed in the asylum of
Chalons-sur-Marne. Since his admission he has been one of the most
industrious and manageable patients, but still maintains his inalien-
able right to the property. M. Foville regards him as labouring
under incurable dementia.

The Utility of Family Life in the Treatment of the Insane, — ^This
subject is treated at some length by Dr. Brierre de Boismont, and is
illustrated by several reports of cases treated in the writer's own
family. "When we took the superintendence in 1838 of our first
establishment,'^ he says, " the insufficiency of the premises, their
bad arrangements, and the impossibility of satisfactorily improving
them, suggested to us the idea of receiving into our own apart-
ments those patients who showed probabilities of recovery. . . .
We relied for the execution of this experiment on our worthy
spouse. The attempt was delicate, but the results were very satis-
factory ; for of the first twelve patients whom we chose, eight were
cured/' Under the kind and continuous care of so distinguished a
physician as M. Brierre de Boismont, many cases, as might have
been expected, were nursed into sanity. But the details of these
recoveries are not so interesting as the opinions expressed by M.
Brierre in regard to the advantages of domestic treatment. He
attributes the good results of the system chiefly to feminine influ-
ence. " The character of man," he says, " cannot bend itself to
this kind of slavery. The attempt to do so is, indeed, most dis-
tressing, as one must listen continually to the same complaints, the
same pains, and the same demands. These repetitions last for hours
and sometimes days ; they are mingled with disagreeable remarks,
irritating words, insulting reflections, and even the infliction of
bodily injuries, and very often accompanied by lying, slander, and
calumny. The character of woman accommodates itself better to
these incessant annoyances. We cannot, therefore, sufiBciently
impress on medical men who propose to devote themselves to the
care of the insane, the great importance which attaches to their
choice of a wife ; for she may render immense services to the
establishment, and it is she alone who can render them. Much has
been said during past years concerning family treatment. We believe

1868.] of P^chological Medieine, 571

that we jh^ake no mistake in saying that we have pat it in practice
for a long time. Sach is at least the testimony borne by the cele-
brated Ferrus, at the meetinpf of the Medico-Psychological Society,
of 26th June^ 1860, when the question of Gheel was under discus-
sion. We quote his words verbatim — " The colony of Gheel/' said
he, " has been quoted as an example. Better a hundred fold for
ihe insane is a restricted, judicious, and scientific liberty, such as
M. Brierre knows how to give to the patients in his maison de sante,
to the good management of which I have been a witness.'* While
reproducing with gratitude this eulogium of an inspector-general,
we hasten to declare that by the aid of M.M. Parigot and Bulckens,
the colony has made considerable progress ; but let us also add that
the infirmary is the commencement of a closed asylum, and that
from this point of view the colony enters upon a new phase, the
system of mixed colonization which we believe to be preferable.''

"The advantages of family life, especially for depressed mono-
maniacs, are too evident to require that we should insist on them
further. For the application of this part of moral treatment there is no
necessity for superior qualifications ; an honest, good, religious heart
will succeed very well. The man of genius will, by exceptional
rules, sometimes obtain surprising recoveries ; but the kindly
person, who, in spite of their bad qualities will consider the insane
as children that are confided to him, and will remain continually
among them, will obtain recoveries less brilliant, but more fruitful
and certainly more permanent. This result is not the only one;
there are others which are not less positive. Patients are brought
to us who are intractable, discontented with every thing, excited,
under the belief that they are surrounded by enemies, unwilling to
do anything that they are asked to do, unreasonable in their actions,
continually complaining, obstinate, and even unbearable. When
scarcely a few days from their admission have passed, the living in
common has a softening influence on their characters, and they soon
begin to get on harmoniously with the other boarders. No doubt
this cannot yet be called a cure ; but submission to the rules of th6
place is in itself a decided improvement. There is another conse-
quence of this mixing of both sexes, under the superintendence of
one of the chiefs of the establishment, and with such precautions
as the nature of mental affections requires ; that is, the activity, the
animation, the normal appearance, and the air of life which is pre-
sented by the patients thus assembled.

" Compare the spectacle before you with that of divisions where
sexes are kept apart, where the sections are multiplied, and, I am
not afraid to say, where the patients are penned up ; and it is im-
possible that the most superficial observation would fail to seize at
once the difference between the two methods. The deduction is
quite ;gLatural; if you wish to send back into society those patients

B7£ Report on th^ProgrcM [Jan.,

who have required to be secluded^ let them see the good features of
that society^ by performing towards them the functions of a con-
soler^ in a word, of a friend, the physician to mind and body.

^^ Analogy, which must not be confounded with identity, enables
us, however, to make certain well-founded comparisons. Thus it is
long since we wrote : the insane are children — we might have added,
spoiled children. It is no part of our intention to criticise public
education, but it is incontestible that private education has the ad-
vantage of disclosing the character of the child before he becomes
reticent, and allows the germs of his future to penetrate his indi-
viduality. If the parents are properly impressed ^ith their duties,
if they are equal to their mission, they may be able by their daily
contact, their advice and their example, to develop and strengthen
that inner force which is called conscience. In a certain number
this education will prevent faults, in the greater number it will mode-
rate and circumscribe them, and it will even restore in many cases
those who may have fallen. This familiar, initiative, and up to a
certain point contagious influence is equally efi'ective among the
insane.'^

M. Brierre sums up his conclusions categorically as follows : —

1. Family life mitigates what is disagreeable in seclusion where
such treatment is found necessary.

2. This powerful auxiliary to general treatment is favourable, not
merely to the cure of mental diseases, but it sometimes even retards
for years the progress of the chronic condition.

3. In enabling to restrict the number of sections, family life
actually removes the cloistral character, and makes a nearer resem-
blance to an ordinary house.

4. The incessant action of family life unobtrusively undermines
delusive ideas, and puts a stop to those sudden manifestations which
attest their influence over the patients. Direct argument, or senti-
mental emotion on the other hand, almost always fail during the flrst
period of mental derangement.

6. The time when family life ought to be commenced, varies
according to the symptoms; sometimes it is suitable from the
beginning, at other times it is necessary to wait until the acute stage
has lost some of its force.

6. This daily and continuous observation, which reveals the
periods when it may be proper to employ argument, is not less in-
dispensable for the study of the legal responsibility of the insane.

7. The superintendence of this treatment does not require superior
qualities; extreme patience, and kindness combined with flrmness,
suffice to attain the end.

8. Woman, by her devotion and her religious tendencies, is
eminently suited for this mission. She ought to be assisted in the
work by her family, or, when that is wanting, by » select staff.

•] 868.] of 'Psychological Medicine. 578

9. The patient's family cannot ordinarily manage the insane, for
it is often the point of outbreak in their maladies^ and it cannot
bring new influences to bear upon them.

10. The simplicity of the means ought to be so much the more
acceptable, as it is only an application of psychological medicine.''

Passion, Immorality, and Insanify, — In this article M. Tissot
as usual disregards all considerations except those of a purely
psychological nature. " Passion," he says, " in the ordinary sense of
the word, is an exaltation or depression of the sensibility, which makes
those persons and things with which the passion is connected appear in
an illusory or deceptive light, which forcibly excites or enervates
action and tends to subjugate liberty, in spite of the protests of
reason. '^ Immorality and insanity" he regards as being only
advanced stages of the same condition where the reason becomes
weaker and weaker. '' Passion is only at the gates of the soul
which it besieges. By reflection, effort, and wise measures, it may
be repelled, driven away, banished beyond recall. Immorality, on
the contrary, has penetrated into the soul ; it has established itself
there as sovereign, but although ruling it, still permits it to exist,
blinded, subject, and enthralled however. Insanity more than
captivates or enslaves ; it take away its personality, transforms it in
a manner into its own image, and places it completely at its
command." From these speculative considerations, he approaches
the question of imputability or moral juridical responsibility.
Passion, immorality, and insanity are separated by no disthict lines
of demarcation, but pass into one another imperceptibly ; and we
are possessed of no dynamometers sufficiently delicate to measure
their degrees ; and we can never tell how much or how little guilt
attaches to any action. In considering the question of punishment,
however, M. Tissot remarks, that " the right of punishment as a
right to re-estabhsh order in the moral world, by means of retribution
or correction, presupposes two things equally false, that man has the
power, or that it is his mission." He has, however, the right to
uphold in human society the dominion of material justice, and what
is called social order. In other words, man has the right to protect
himself against man. '^ It appears," says the writer, " that in the
question which lately agitated the Medico-Psychological Society,
we should have sided with those who believe in moral laws, and in
the free will necessary for their fulfilment, and who admit a partial
responsibility and liability to punishment wherever there is a
partial knowledge of the criminal act on the part of the agent, with
partial reflection and partial liberty of action. But we acknowledge
also that the imagination may present such seductions, and the
appetite such temptations, that the idea of duty and of its holiness
would be much weakened, and the liberty of action much diminished."

574 Report on the Progress \ivxL,

Paralytic Dementia observed in the Island of Cuba, by M. Ic
Docteur Munoz. — (This paper has been already translated in full for
this Joamal; by Dr. Mackenzie Bacon. Vide * Journal of Mental
Science/ No. lix, Oct. 1866, p. 383 et seq.)

MedicO'Legal Inquiries relative to Insanity. — M. Dagonet pro-
ceeds in this paper with his analysis of the work by Mittermaier.
In this portion of his treatise, the learned author examines the
question now public action ought to be conducted, in order to obtain
an equitable judgment, and to disentangle satisfactorily the respon-
sibility of the accused. The medical experts, he says, ought not to
be assimilated to witnesses, nor ought they to be considered as
auxiliaries to the judge ; and it is of importance not to confound the
proofs established by the physician with those obtaineil by the
magistrate from his own point of view. The aim of the expert lies
in transmitting to the jury, and imbuing them with, the conviction
which he himself has formed. Shauenstein expresses the opinion,
that the sentence of the jury is frequently a vote of confidence ac-
corded to the authority of the man whose duty it has been to give
his opinion on the medico-legal question. The same author also
remarks how much one is dis|)Osecl to overstep the limits of medical
competence when a doubt arises as to the mental condition. The
fault may be in the want of knowledge of judges and lawyers in
what relates to natural science ; but it arises also from the medical
men not having enough of independence and moral force to refuse
to reply to questions which do not come within the sphere of their
knowledge; and much more frequently from vanity, or from
ignorance of the limits of their competence, they give opinions
which are only personal, and can only be properly given in their

f>rivate capacity. The views adopted, in much recent continental
egislation, have added difficulty to, rather than facilitated the mode of
dealing with, the question of insanity. It is not reasonable, for in-
stance, to ask if such and such a person has acted of his own free
will. Free will, considered both as a faculty and as a force, is
present in every one, even in the insane, only the action of this free
will may, in certain cases, be impeded. This question ought so much
the less to be put, as the expression bears a great many significations.
The legislator, who would comprehend in one formula the doctrine
of responsibilitv, runs in danger of trenching on the domain of
philosophy, and would risk being restricted to a scholastic language,
as various and misleading as there is want of correspondence between
philosophical expressions and those which are jundical and usual.
A conscientious physician would often be unable to say whether free
will is completely suppressed ; and it is an error to suppose that
there are such mental affections as partial insanity, as it is called,
wiiere.inesponsibihty ought to be admitted only when an.iutim^te

1868.] of Psychological Medicine. 575

connection can be shown to exist between the predominant fixed idea
and the act committed.

Free will, according to Mittermaier, ought to be considered as an
innate faculty in man, which manifests its power in a condition of
health, by a determination towards moral and honorable acts, such
as reason would approve, and by a resistance to the temptations
which the caprices of the imagination and perversion of feeling may
provoke. Eesponsibility he defines as that situation in which every
person is, when in a state to recognise the nature and consequences
of his acts, and when his free will has not been paralysed by disease,
or by some previous and insurmountable restraint.

MedicO'Legal Report on the Case of Seiler. — ^This report is also
from the pen of M. Dagonet, and refers to a man named Boniface
Seiler, who was accused of setting fire to the house which he in-
habitated. He had shut up his workshop and dwelling, and had
taken care, before ap})lying the fire, to remove all objects above a
certain value. At the examination which he underwent after
having been arrested, he stated that he had suffered serious loss,
which, unfortunately, the insurance would be far from covering.
The juge d'i/islruction immediately showed him the articles which
he pretended to have lost, and remarked that he might make himself
at ease on this score, as everything had been found. In presence
of this overwhelming proof of his guilt, Seiler was seized with
unutterable terror, he remained speechless, and it was thenceforward
impossible to obtain any kind of explanation. Eemitted to prison,
he was soon seized with an attack of cerebral congestion, which
gave place to a condition of stupidity. He preserved the most
obstinate silence ; but it was thought that he might be simulating
insanity, and he was sent to the asylum of Stephansfeld, of which
M. Dagonet was then physician-in-chief for his opinion.

In his report, M. Dagonet goes carefully into a discussion of
the case, and comes to the conclusion, that under the influence of
the profound terror which overcome him, at his interview with the
judge, he was seized with an intense cerebral congestion, well
marked and scarcely admitting of being simulated. 'I'he principal
symptoms which he exhibited, were a comatose condition, paralysis
of the right side, and an abnormal frequency of the pulse; and
these continued for several days. These symptoms gave place to
a condition of mental derangement which, there is reason to fear,
may pass into dementia paralytica. After the date of the report,
Seiler began to improve, and ultimately regained his speech, one
use he made of which was, to assert his innocence of the crime
with which he was charged. At the time of the publication of the
report, he had not been brought to triaL

In a subsequent number of the ' Annales' the result of the trial is

576 Report on the Progress [Jan.,

given. The improvement which had begun had gone on, so that
when his case came on he was apparently quite recovered. The jury
returned a venlict of guilty with exttuiuating circumstances, and he
was sentenced to five years of hard labour.

Medico-Legal Report on the Case of MoUard, by Dr. Henry
Bonnet, Physician to the Asylum at Mar^ville. — About the year
1862, the accused threw a piece of wood at his father and hit him in
the chest, in consequence of his having been found fault with by the
old man. Towards the end of October, 1864, he threw a tub at
his father^s head but did not hit him. On the 11th of November
following, his father requested him to desist from some noise he
was making nlose beside him- Instead of complying he made still
greater noise, uhen his father struck him a blow on the arm with a
fire-shovel he had in his hand. The accused thereupon threw a
ladle and skimmer, with which he had been beating the table, at his
father's face ; but having missed his aim he exclaimed — " You shall
pay for that blow.'' He went into an adjoining apartment and soon
returned with a vase de nuit, which he dashed against his father's
head, and upon which it broke. The blood flowed abundantly, but
the wound did not disable him from work. When examined, both
by the commissary of police and by the juge d* instruction, the
accused answered questions clearly ; but his parents having spoken
of him as having suffered from mental derangement, and he himself
having declared that he was sometimes discomposed, it was ordered
that he should be subjected to medical examination. This was confided
to M.B&het, of Nancy, and afterwards to M. Bonnet. When brought
to the asylum he appeared to be calm and intelligent ; but when taken
to the division of the asylum in which he was to reside, it was observed
that, contrary to what is usually observed among the really insane,
he became excited and appeared to be much afraid of being placed
along with the patients. Afterwards he became calm and continued
80 during his residence in the asylum. He was also obedient, and
regular in his habits; he ate with good appetite and slept well
The result of the inquiry was, in M. Bonnet's opinion, that he had
suffered from bad primary education and surroundings, that con-
sequently he goes wrong occasionally ; that he is very much under
the influence of anger, a condition which does not in itself constitute
a nosological entity ; and, in conclusion, that he has never been
insane, and was possessed of freedom of will at the time of the
assault. MoUard was condemned to two years' imprisonment.

Medico-Legal Report on the Case of Louis P. — ^This report by
MM. Bourquet and V. Combes, refers to a man who murdered his
father-in-law. The two men had quarrelled about monev matters,
apparently connected with the amount of property which the one

1868.] of Psychological Medicine, 677

was to receive from the other as dowry ; and being on their way to
mow grass on the morning of the fatal occurrence, P — struck the
other on the head with his scythe, and, after repeated strokes,
smashed the calvarium and then fled, leavitig his companion dead on
the ground. After tlie murder and before his capture he made
ineffectual attempts at suicide, on one occasion inflicting a consider-
able wound in attempting to cut his throat. In other ways he
conducted himself in a restless and eccentric manner, so that his
friends believed him to be insane. The authors of the report, how-
ever, to whom the case was referred, report that neither before nor
at the time of the deed is there any evidence of his having been
insane, and his conduct since is rationally accounted for by mere
remorse and fear of the consequences. He was found guilty of
murder with extenuating circumstances, and was sentenced to fifteen
years' hard labour.

Medico-Legal Report on the Menial Condition of Jacques Baud, —
This is also from the pen of M. V. Combes, and refers to a demo-
ralised wretch of sixty years of age, a species of satyr, who was
accused of having exposed his person on various occasions before
young girls, and who had, on four occasions, either committed or
attempted to commit rape on four difierent girls. M. Gombes con-
siders that he ])ossessed capacity for the discharge of the ordinary
affairs of life, but only an instinctive discharge, not a rational one.
The memory was intact ; he had the feeling of authority, and there
might even be some traces of emotional faculties ; but what appeared
to be most frequently absent were will and moral sense. ^^ As is usual
with imbeciles, filthiness is a prominent characteristic of his. The
feebleness of his character and of his will, led him to address especi-
ally young children ; and if it has been thought, in certain cases,
that he was conscious of the culpability of his acts, a mere act of
memory has been mistaken for a moral one ; Jlaud had no idea of
the intrinsic and moral value of an action. Considering that he had
a very incomplete appreciation of good and evil, and considering
the powerful and brutal tendencies which he had not moral energy
enough to repress, it is impossible that he could be possessed of free
will, and cannot therefore be responsible for his doings.'^ Adopting
these conclusions, the public prosecutor abandoned the prosecution.

{To be continued,)

57S [JaiL,

PART IV.-NOTES AND NEWS.

Impcriant Lunaey FroMeeuiiatu.

Sotf s impnrtanC hmMcj prosecQtioos hmwe reeentlj been undertaken hj
tbe CoromiMMners of Lnnacj a^nst a Dr. Edward Charles James Shaw,
reaiding at the Fira, Boreham Wood, Elstree, Hertfordshire. The charges
against him are under the 8th and 9th Yict., cap. 100, sec 90, for taking or
baring charge of a lunatic fur pro6t, without the eerti6cate required br the
Act, and under the 16th and 17th Vict., cap. 96, sec. 9, for lutTing wilfuUj
neglected the lunatic.

The first case was heard at the Bow Street Police Court on the 28th of
Kf/rember, when cTidence was adduced on the part of the prosecution thai
the defendant bad been harbouring an alleged lunatic, and tbat be was not
proTided with the requisite licence.

Dr, George Fielding Blandford, of So. 3, Clargea Street, who was
examined upon that occasion, described the appearance of the rooms at the
Firs when he.Tisite<l it on the 3 1st of October last. The room in which he
found the alleged lunatic (a Mr. Clode) was about 12 feet square, with a
window, and a boarded floor about six inches high, it cf»ntmined a wooden
French bedstead. The bedding consisted of two old mattresses, one on
top of the other, and in a Terj 61thj condition. Tbej were Terj wet, espe-
cially in the centre, where there was a great hollow from a person's weight
Orer the patient was a piece of old drugeet, also in a verj filthj state.
There was no other bedding, neither was there a pillow, bolster, or sheets.
There was a piece of bass matting under the mattresses. Upon looking un-
derneath the bed, the witness saw water dripping from the ends of the
mattress, which protruded under the most depressed part of the bedstead.
The patient had nothing on but an old flannel shirt, the lower portion of
which had been rotted on. After describing the appearances of dirt and filth
about the room. Dr. Blandford added that there was no fireplace in it. The
patient was neither emaciated nor fat. He stated bis name and address cor-
rectly, and lii>w long he had been there. He said that the place was certainlj
in a most disgraceful state. Witness saw the patient agam on the 6th and
8th of November, and gave it as bis decided opinion that the man was of un*
sound mind. In answer to certain questions which Dr. Blandford put to
him, the defendant said, respecting the disgraceful state of the room, that
the patient was of very dirty habits, and that it could not be helped. Hii
friends did not pay enough to enable him to keep the man in a better state.
The defendant also repli^ that the patient was not a lunatic, because be had
no delusions, but that be had suffered from paralytic attacks, and had com-
pletely lost his memory. He was not placed under any restraint, but was
allowed to take walks in the neighbourhood. He was not allowed any
money, as, if be were, he would eet drunk.

In answer to questions put by Mr. Merriman, who appeared for the
defendant, witness said that he did not see anything indicative of an
unsound mind, but that the defect of memory was such that he considered
it conclusive proof of an unsound mind. He did not recdlect that the

1868.] Notes and News. 579

imtient made any complaint as to a want of food, nor did he ask him the
quet»tion.

The case was adjourned, and upon being resumed on the 29th of
November, Dr. James Risdon Bennett, one of the physicians of St.
Thomas's Hospital, was called. He also saw the patient, and said that,
judginf^ from the whole conversation he had with him, the patient's habits,
and other symptoms, he should say that Mr. Clode was not only of unsound
mind, but had hardly any mind left.

It was then proved by Mrs. Charlotte Townhend, of 63, Clarendon Road,
Notting Hill, that she liad known Mr. Clode all her life. He married her
sister in 1834, and carried on business as a wine merchant at Brighton. He
had had three attacks of paralysis, the last in 1863. After that ne suffered
from loss of memory. He so mismanaged his business that he was obliged
to give it up. They advertised in the * Times' for a home for an invalid
gentleman. They had no thought of the mind in that advertisement.
Engagements were entered into with Dr. Shaw to take care of Mr. Clode, at
the rate of £5 per month, and subsequently £lO per month. The increase
was asked for in consequence of the dirty habits of the patient.

In answer to Mr. Merriman, the witness said that Mr. Clode had been
bankrupt, and the expense of his residence in Dr. Shaw's house was paid
by his wife. His wife was formerly possessed of considerable property, and
had spent it all upon him. Dr. Shaw had frequently expressed a desire to
be relieved of his charge, but his friends had no desire to have him removed.
They were satisfied with his treatment.

Another adjournment was asked for on the part of the prosecution, and
when the case was again resumed on the ^ih of December, Mr. Merriman
called witnesses for the defence.

Mr. Godstow, a general practitioner, and surgeon to the Barnet Union,
stated that he saw Mr. Clode in 1865, and gave an opinion that he was not
a lunatic. He was suffering from chronic softening of the brain, inducing
partial paralysis and loss of memory, but in other respects in good health
and free from delusions or other indications of insanity. He did not con*
sider the place uncomfortable, certainly not wretched.

Cross-examined by Mr. Poland for the prosecution, the witness said he
should say that Mr. Clode was not a lunatic, but that he was a person of un-
sound mind. He could not certify that he was a person who ought to be
taken charge of and placed under care and treatment. He ought to be
placed under care and control, but not deprived of his liberty.

Questioned by Mr. Vaughan (the magistrate) Mr. Godstow replied that it
was very difficult to define insanity. He should not consider a person insane
who had no delusions and was not dangerous to himself and others. If a
person had delusions and was dangerous he should say that he was insane.
Delusions were the principal symptoms of insanity.

Mr. Edwin Joseph, a surgeon of Barnet, who had been in practice for
twenty-two years, said that he had come to the conclusion that Mr. Clode
was not insane, and certified to that effect. He had been present at those
proceedings, and after hearing the evidence he should not feel justified
in certifying that he was a lunatic, or of unsound mind, and ought to b.

E laced under restraint. He required care and kindness, which he cousidered-
e had at Dr. Shaw's.

In reply to Mr. Poland, the witness said that he did not consider Mr.
Clode to be of unsound mind within the meaning of the Act. He should
say that he was of defective mind. The patient was senile ; he was prema-
turely old from excess. When sober he should say that if be had money he.
could go and take lodgings for himself, buy provisions, and generally tak(^:
care of bis affairs.

580 Notes and News. [Jan.,

Ke-examined by Mr. Merriman, the witness agreed with Dr. Godstow that
Mr. Clode ought to be placed under restraint. He did not agree with him
that there was softening of the brain. He thought that the derangement
arose from the spinal marrow and not from the brain at all.

In answer to Mr. Vaughan, the witness attributed the loss of memory to
premature old age, the result of excess. He did not consider loss of memory
a symptom of unsoundness of mind, though it might accompany an unsound
mind. In a person of unsound mind he should expect the drawing of
unsound conclusions and incoherency ; in a person of defective mind loss of
memory.

The case was again adjourned, and when it was again brought before the
attention of the magistrate the defendant was committed to take hb trial at
the Hertford Assizes.

Another Charge against Dr, Shaw,

At the Bow Street Police Court on the 13th[^December Mr. Vaughan heard
another charge against the same defendant for an infringement of the
Lunacy Laws, by keepinor a Mrs. Frances Danvers Weston, an alleged
lunatic, without having a licence according to the Act of Parliament.

Mr. Poland, barris^ter, appeared for the Commissioners of Lunacy, and
Mr. Merriman, solicitor, for the defendant.

Mr. Poland, in informing the magistrate of the facts of the case, said that
the Commissioners of Lunacy felt it to be their bounden duty to investigate
this case, in order that it might be seen whether it was one which should be
sent to the assizes. In the present case the patient, respecting whom the
inquiry would be made, was Mrs. Frances Danvers Weston. She
was a person of some property, having about £6100 in the consols. It ap-
peared that she married Mr. Weston in January, 1851, and in April, 1858,
being then insane, she was removed to Great Foster House, Egham, Surrey,
and there con lined under a regular medical certificate. She was there imtil
the 1 1th of February, 1865. On that day she was [discharged from that
asylum, and was taken away by her husband. He should prove by Mr.
Edward Thomas Furnivall, one of the medical witnesses, that at that time
Mrs. Weston was in no way relieved. She suffered delusions of a peculiar
character, and there could be no question that she was a right and proper
person to be under care in a licensed establishment. It would be shown
that after she left Great Foster House she went to the establishment which
was kept by the defendant. There was no doubt that the sum paid to Mr.
Shaw for her board and attention was &Q5 a year. There was reason to
believe that she remained at Dr. Shaw's from 1865 until the 6th or 7th
of November in the present year. On the 31st of October Dr. Blandford
went to Dr. Shaw's house at the Firs, and endeavoured to see this lady, but
was unable to do so. He went again on the 6th of November, but was still
unable to see her. Whether these two visits alarmed Dr. Shaw or not, he (th«
learned counsel) could not sav, but the prosecut ion would show that lomt
time about the 6th or 7th of November, Fanny Wheeler, Dr. Shaw's senrant,
took Mrs. Weston to Bicester, in Oxfordshire. Having thus taken Mrt.
Weston away on the 6th or 7th of November,^ Fanny Wheeler returned
home without her on the 8th. These matters were notorious, and it was
thought by the Commissioners that Dr. Blandford should go to Bicester.
But when there he was* unable to find her. After considerable difficulty
Mrs. Weston was found living with her husband's aunt^ a Mi^. Osborne, at
No. 4, Church Street, Murray Street, Hoxton. When Dr. Blandford saw her .
he found that there was no question of her insanity. She bad delusions of

1868.] Notes and News, 581

many kinds. Subsequently Dr. Bennett visited her, and be would confirm
Dr. Blandford, and say that undoubtedly she was insane, and a person who
ought to be taken under proper treatment. To show that she was confined
in the establishment of Dr. Shaw, he should call a charwoman who had been
in the constant habit of working at the Firs, and who would say that she was
the same person as she had seen there. A police sergeant, who had seen
Mrs. Weston on one occasion at the police-station near The Firs, would also
identify her. On the occasion of her being at the police-station she was
brought there by a constable. She was then very miserably clad ; she had
no stockings, her dress was unfastened, and her hair was matted. Mr. and
Mr. Shaw came and fetched her away. Aftei; some further remarks
respecting the evidence which would be brought before the Court, the
learned counsel drew Mr. Vaughan*s attention to the fact that Mrs. Weston
was a lady of property, confined without a certificate ; and when they found
that medical gentlemen were going down and inquiring about her, she was
suddenly removed, and no trace could be discovered of her. Under these
circumstances the Commissioners considered that it was their bounden duty
to investigate the matter, and call upon the defendant to answer the charge
in another court. The Act under which these proceedings were taken was
for the protection of lunatics and their friends. It was most important for
the public good that the Commissioners should know where these unfortunate
persons were confined.

Mr. Edward Thos. Furnivall, who was the first witness called, said, — I
am a surgeon, living at Egham, Surrey. In 1858, 1 was part proprietor of
the Great Foster House, at Egham. That was a house licensed for the re-
ception of lunatics, male and female. On the 26th of April, 1858, Mrs.
Frances Danvers Weston was admitted to my house as a patient. She was
confined there as one till Feb. 11, 1865, under certain certificates (produced)
duly signed by two medical men. One hundred guineas a year was paid for
her keep at first; £52 10s. half-yearly. Subsequently, at the request of Mr.
Weston, her husband, this charge was reduced to the sum of £100 a year,
and again to £84 a year. She was discharged from our house at the request
of her husband.

Mr. Poland. — Was she relieved in any way when she left your house ?

Witness. — No ; I told him at the time that she was not altered, and I gave
him the necessary instructions to have her removed to a private asylum, and
he said he was going to do so.

Mr. Poland. — During the time she was at your house was she a lunatic ?

Witness. — She certamly was an insane person, and one labouring under
delusions.

Mr. Poland. — State one or two of those delusions.

Witness. — She carried the cat about with her constantly, and said that she
held conversations with it ; that the cat was perfectly able to understand
what she said to it ; and that she could understand what the cat said to her.
She was also under a delusion with respect to certain bed-curtains. She
said that before she was sent to our asylum she had laid in bed two
years before she could get them. She also fancied sometimes that she was
the Queen, at others that she was a great lady ; again, that she set the
fashion. She would strut about the room saying that she was the Queen,
and that she set the fashions.

Mr. Poland. — Was she violent ?

Witness. — She was. On one occasion she struck her hand through a pane
of glass, and on three occasions, in 1864, she had to be secluded for excessive
violence in striking her attendants and another patient. She was very lady-
like, but very indolent, requiring to be aroused before she would do anything.
On Monday, the 9th of the present months I went to No. 4, Church Street,

VOL. xm. 40

582 Notes and New9. [Jan.,

Murray Street, Haxton. I found Mrs. Weston there in bed. I had a con-
yersation with her lasting a quarter of an hour or twenty minutes.

Mr. Poland. — In your judgment is she still a lunatic ?

Witness. — In my judgment she still labours under the sjame delusions, is i^
lunatic and an insane person.

Mr. Merriman did not cross-examine this witness.

Dr. George Fielding Blandford. — I live at No. 3, Clarges Street. Am a
member of the College of Physicians and a doctor of medicine. I have had
a large experience on the subject of lunacy. On the 3 1st of October last I
went to the house of the defendant at The Firs, Boreham Wood. I had an
order from the Lord Chancellor authorising me to visit that establishment.

Mr. Merriman. — That*order must be put in.

Witness. — I went into the house, and asked to see all the inmates. I was
told I did see all the inmates ; but I did not see Mrs. Weston there. I saw
three ladies and Mr. Clode. At that visit I went into all the rooms, as I then
thought, but I afterwards discovered that there was one bed room which I
did not see. I saw Mr. Shaw on that occasion. On the afternoon of the
6th of November I visited The Firs again. The defendant was not then at
home. I did not see Mrs. Weston there then. This time I asked for her hy
name.

Mr. Merriman. — This is not evidence, as the doctor was not in.

Witness. — ^I did not see Mrs. Weston there, but I went over the house,
and into the room which I did not visit before. On the 8th of November I
went again to the defendant's. I did not see him then, as he was out. 1
inquired for Mrs. Weston, but did not see her.

Mr. Poland. — ^In consequence of some communication, did you go to
Bicester, in Oxfordshire ?

Witness. — ^I went there on the 9th, with the object of seeing Mrs. Weston.
Amongst other places, I went to the house of the mother of l^anny Wheeler,
the servant. I was not able to find her (Mrs. Weston) there. On the 23rd
of November, I went to No. 4, Church Street, Murray Street, Hoxtun. I
there found Mrs. Weston. She was living with Mrs. Osbom, her husband's
aunt. She told me on that occasion her name was Frances Danvers Weston.
I was talking with her for about an hour.

Mr. Poland. — In your judgment is she a lunatic and insane person ?

Witness.— Decidedly she is. She was suffering from delusions. She tol4
a long story about bed-curtains, which has been mentioned. She said that
they were conjuring curtains, and that they would come to her by magic.
She told me that she had stayed in bed two years, waiting for these curtains
to come to her, and that when they did not come at the end of two years
she was taken to Great Foster House. She told me further, on that oc-
casion, that nobody was dead. She said her father was alive, and also that
the Duke of Wellington was alive.

Mr. Poland. — Did she say which Duke of Wellington ?

Witness. — No, I did not ask her. She also said that her aunt was alive
This conversation arose out of one as to whether her friends were alive or
not. On the 30th of November I again visited her, and on that occasion I
was accompanied by Police-sergeant Sawyer. I had further conversatioa
with her.

Mr. Poland. — From these two interviews are you clearly of opinion that
she is insane ?

Witness. — Yes. She told me that she had had a visit from two gentlemen
the previous week, one of whom was the Prince of Malta. I asked her
other questions, and she said that cats were not cats, but animals of a different
ypecies, called '' Jefferies,** and so called bv Dr. Roberts, of Great I^oster
House. She told me that she saw a man fly past her window, witjlioait VKi
wings, and wiUk a thick skin over him.

1868.] Notes and News. 588

Cross-examined bj Mr. Merriman. — ^I have seen Mr. Weston. I saw him
a few days after my first visit to Mrs. Weston. He came to my house.
That is the only time I have seen him. I do not see him here to-day.

Mr. Poland. — We have tried to find him, but cannot. If he were in
court I should call him at once. If you (Mr. Merriman) can give us any in-
formation about him we shall be very «rlad.

Mr. Merriman. — I shouM be very glad if I could do so.

Mr. Poland. — Did Mr. Weston refuse to give you his address?

Witness. — Yes.

Mr. Merriman. — Did he call upon you uninvited ?

Witness. — Yes. I presume he did so in consequence of my visit to Mrs.
Weston. He gave me to understand that. I asked Mm for his address, but
he refused to give it.

Mr. Merriman intimated to the magistrate that he should reserve his cross-
examination of the witnesses.

Dr. James llisdon Bennett. — Hive at 15, Fihsbury Square. I am one of
the physicians of St. Thomas's Hospital, a doctor of medicine, and a Fellow
of the Royal College of Physicians. On Siiturday, the 7th of December, I
went to K^o. 4, Church Street, Murray Street, Hoxton, but I did not see Mrs.
Weston on that day. I was told that she was having a bath. I went on the
f<»11owing Monday, the 9th, when I saw her. I addressed her as Mrs.
Weston. Mrs. Osborn, the aunt, went into the room with me. I remained
with Mrs. Weston abcmt three quarters of an hour. I had a conversation
with her, and formed an opinicm respecting her state of mind.

Mr. Poland. — In your judgment is she a lunatic ?

Witness. — In my judgment she is insane, and a person who ought to be
kept under proper care and treatment.

Mr. Poland. — In the course of the interview did you ascertain that she
was suffering from various delusions?

W^itness. — I did. I had a conversation with her for some time before they
came out. I was anxious that they should appear spontaneously, rather
than be elicited by me.

This witness was not cross-examined.

The two previous medical witnesses had also agreed that Mrs. Weston
was a person who, in consequence of her insanity, ought to be kept under
proper care and treatment.

Sergeant Wm. Sawyer, A R. 768. — I know The Firs, the defendant's
premises. There is a police-station at Shen ley Hill, near Barnet. It is
distant about two miles and a half from The Firs. I was there last
February, when a lady (;ame there about half-past seven o'clock in the
morning. She was brought there by a police-constable. I thought she was
an insane person, and detained her on that ground. She had no bonnet on,
no stockings, an old pair of boots, an old brown lindsey dress, open all up in
front. Her hair was matted, and looked as if it had not been combed out
for months. It hung over her shoulders. A conversation took place, and
she said that she had a friend, a General Brooks, living at the Black Forest,
Windsor. She said she had lived there, and also at Cheltenham, but that
she did not like the latter place, as it was so damp. She said it was 9000
miles below the level of the sea. Between eight and nine o'clock the same
day the defendant and his wife came to the station. They were in a dogcart.
Mr. Shaw stopped outside with the horse and trap. Mrs. Shaw came into
the station. She brought a bonnet and cape with her. They took this lady
away with them in the dogcart. On the 30th of last month I went to
No. 4, Church Street, Muiray Street, Hoxton, with Dr. Blandford, and I
found the same lady there.
Emma Coughtree. — I am an inmate of the Hendon Union. My husband

584 NoieM and Newt, [Jan.j

is dead. In the montii of Maj last I went to Mr. Shaw's, at The Fin,
Boreham Wood, for the purpose of washing, once a fortnight, and once
a week todeanse Mr. Clode's rooms. When there, finom time to time I have
seen Mrs. Weston. I saw her there last on the 6th of Norember. The
senrant, Fanny Wheeler, was in the house then. On the following daj Mn.
Shaw came to my cottage and made a statement to me. The next momine
I went to the defendant's house. I remained there till the afternoon, an3
did not see anything of Fanny Wheeler or Mrs. Weston. I saw Fanny
Ulieeler again on the 8th. When I saw her I was standing at my gate. She
was then alone. I saw Mrs. Weston at No. 4, Church Street, Murray
Street, Hoxton, on the 24th of November. I had seen Mrs. Weston at The
Firs cleaning knives and forks, boots and shoes, washing plates, dishes, and
saucepans, siAing cinders, and turning an oat-crushing nuu;hine. She took
her m«ds in the back kitchen by herself. Fanny Wheeler was the only
domestic servant.

Cross-examined. — On the 7th, when at The Firs, I saw Mrs. Shaw and
Dr. Shaw there the whole time. On the 8th, when I saw Fanny come home,
she might have come from Bamet. A messenger from the office of the
Commissioners of Lunacy, who is now present, went with me to No. 4,
Church Street.

By the Magistrate. — VMien at The Firs I have never seen Mrs. Weston
walking about.

Re-examined. — My cottage adjoins the back of the stables at The Firs.

Mr. Durant, of St. Albans. — I am a solicitor and deputy clerk of the
peace of the county of Hertford, of the liberty of St. Albans, and of
Elstree, within the limits. I should be acquainted with any licence which
was granted by the justices. No licence has been granted to Dr. Shaw
authorising him to keep the premises known as The Firs for the reception of
lunatics.

Mr. Thomas Martin, chief clerk in the office of the Commissioners of
Lunacy, was called to prove the practice as regards the certificates which
authorise qualified persons to keep lunatic and insane persons in their
asylums. The defendant's house, The Firs, had not been registered as an
hc»pital or asylum for the reception of lunatics. The defendant had not
made any returns respecting a lunatic named Frances Danvers Weston,
according to the requirements of the Act of Parliament. He had not sent
in any documents respecting that patient at all.

Cross-examined.—! have not seen Mr. Weston, nor do I know where
he is.

. Mrs. Charlotte Townhend, of 63, Clarendon Road, Nottins HiU, proved
that she knew the defendant, having corresponded with hun. She had
received a large number of receipts from him respecting the payment for the
maintenance of Mr. Clode.

Mr. Poland handed the witness certain receipts for the maintenance of
Mrs. Weston.

The witness said that to the best of her belief the handwridng was that of
Dr. Shaw. The receipts were dated from the 1st of April, 1865, till the 1st
of October, 1867.

This was the case for the prosecution.

Mr. Merriman briefly addressed the magistrate on behalf of the defendant.
According to his instructions, he said there was the clearest possible answer
to the charge. The prosecution had brought forward no evidence as to the
circumstances under which this lady was placed wi^ his client. He thought
it was most material that such evidence should have b€«n given. If ^at
evidence were forthcoming, it would show that Dr. Shaw took chai^ of Mrs.
Weston as he did of other persons who came to his establishmant for the

1868.1 Notes and News. 58$

benefit of their healthy as invalids, who came there volnntarily. It was
within the knowledge of the Commissioners that persons did go to his house
as invalids. He asked whether, in the default of such evidence, the case
should go to the sessions. The reason that he had not cross-examined the
witnesses was that if the magistrate thought there was a bond fide case
it would be a waste of time. There was another case against the defendant
which would come on at the same assizes. With all respect, he submitted
that a bond fide case had not been made out without the production of
Mr. Weston, or something beyond what they had heard.

The magistrate did not think it was necessary for the prosecution to
go into the circumstances under which the alleged lunatics came into Dr.
Shaw's house. They had sought for Mr. Weston and could not find him. It
was more a matter for the defence. It was quite sufficient for the prosecu-
tion that the lunatic was there, that no licence had been granted to the
house, and that no return had been made to the Commissioners. It was per-
fectly certain that she was received there for the purpose of profit. He had
no futemative but to commit the defendant to take his trial at the spring
assizes.

The magistrate consented to take bail, defendant in a sum of £200, and
one surety of £100.

Care and Treatment of the Insane Poor.

The address of Dr. C. Lockhart Robertson (president of the Medico-
Psychological Association) at the recent annual meeting has been published
separately, and will well repay jperusal by all those who are interested in the

Eublic arrangements and institutions for the treatment of the insane poor,
^r. Robertson thinks we are not far from a sufficient provision for this pur-
pose. During the twenty years the Lunacy Act has been in force, the
number of beds in the county asylums in England and Wales has increased
from 5500 to 26,000. In 1847 the public asj^ums provided accommodation
for 36 per cent, of the paupjer lunacy of the country; in 1867 there is pro-
vision for 60 per cent., which Dr. Robertson thinks a fair provision, and
which leaves 25 per cent, to be treated in workhouses, and 15 in private
dwellings. The addition of 7000 more beds to the existinff number (26,000)
in the county asylums would meet every want that is likely soon to arise.
Dr. Robertson believes that this addition may be best procured by increas-
ing the number of beds in existins asylums to an average of 600. In 1847,
1 in every 880 of the whole population was a pauper lunatic ; in 1867, 1 in
494. It requires all the authority of Dr. Robertson's opinion to satisfy ub
that these figures do not show an increase in the amount of pauper lunacy.
He thinks tney do not show this, but only more accurato returns, and a
desire in the lower middle class to procure treatment for their relatives in
the county asylums. While allowing the generally satisfactory condition of
lunatics in workhouses, he urges the -placing of them, even there, in the charge
of the justices of the peace, under the supervision <^ the Commissioners in
Lunacy, and the annual visitation of the workhouses of the county by the
medical superintendent or other officer of the county asylum, with a view to
a report on the general condition of the lunatics and the interchange of cases
between the wo^house and the Asylum. In Scotland, 13 percent, more of
the <;ases are treated in private dwellings. . Sixpence a day is allowed to
labourers for such cases. Dr. Robertson — we think justly— condemns the
Scotch practice of granting licenses (without fee) for the care of three oj

586 Note9 and News. [Jan.^

fonr cases in a labourer's cottage, and characterises it as a retrograde step m
the treatment of the insane. We entirely agree with him. These cases are
ostensibly under inspection quarterly or half-yearly, but no Such inspection
will ensure- the proper treatment of the idiotic ibr sixpence a day in the
houses of strangers, undertaken fur pecuniary profit.

We can only hope that the public arrangements for thfe treatment of tbe
insane will soon be completed in the spirit of the great Lunacy Act of 1845.
It is easy to understand that while these are incomplete the medical minds of
this department cannot be at leisure to do their best in the strictly medical
treatment of insanity. — The Lancet, October 19.

L'empereur d'Autricie chez le baron Mundy.

L'empereur Franpois-Joseph a quitt^ aujourd'hui la France, emportant
le meilleur souvenir de Taccueil qu'ily a re9u, et qu*a singuli^rement favoris^
le plus magnifique temps qui se soit jamais vu en cettesaison. Les chroni-
queurs ont suivi ses pas, recueilli ses paroles, k TExposition comme ailleurs;
mais, suivant leur imperturbable coutume, ils ont neglige les episodes les
plus s^rieux de ses courses. lis ont note, par exemple, que Tempereur avait
visit^ la brasserie viennoise, et ils se sont bien garde de dire (sauf le chroui-
queur du Pelit-Joumal)^ qu'en sortant de Ik, il s'^tait rendu dans la maison-
mod^le du docteur baron Mundy, et avait eu avec cet exposant, qui est
chirurgien-major de l^classe dans I'arm^e autrichienne un long entretien.

Telle est pourtant Thistoire vraie. L'empereur a vlsite aT«c le plus
s^rieux int^ret le plan et les details de la maison-mod^le pour le traitement
des alien^s en famiUe ; il a demand^ k Fexposant des explications praises et
les a ^cout^es avec la plus grande bienveillance ; il a aceepte de la meilleure
grace notre livre sur Oheel^ richement reli6, que le docteur lur a offerfe en son
propre nom. Enfin, comme i^moignage de sa haute satisfaction, S. M. Ta
nomm6 commandeur de son ordre de Francois- Joseph. Gette visite pro-
long6e et attentive a d^dommagd un peu le zdle r^formateur de lai)syi*hiatrie
de Toubli oil I'ont laiss^ les jur^s, qui n^nont pas mdmedaign^ jeter un coup
d'ceil sur son ingenieuse et coiiteuse installation, non plus que sur les Etudes
approfondies qui la compl^taient. Mais ils out eu bien d'autres distractions.
Que la terre du Chanip-de-Mars leur soit l^g&re, comme Test la reconnais-
sance de beaucoup d'exposants !

Quant ^ M. Mundy.^ses travaux et ses d^penses ne serontpas perdus
pour la science. Outre Timmense propagande qui r^ulte de son exposition,
visit^e par 2 k 300,000 curieux, il ya reprendre a Vienne le cours de sa pro-
pagande. n ouvrira prochainement daiis cette ville une s^rie de cinq lepons
sur la edonisaiion des aUSads, Get enseignement sera complete par deux
autres cours. Tun sur les instUutiona sanititires en Europe'' et en Amdrique^
Tautre sur la mSdecine UgaU de Paliination ; enfin il lira des chapitres choisis
sur laphreuopatAie, Ges cours auront lieu, les uns dans T Academic Josephine,
les autres k r University de Vienae. — L* Economist Frangaie, 7 Novembre.

. Epileptie Kleptomania.

Will Dr. Maudsley, Dr. Forbes Winslow, or any other of our distinguished
alienists, inform us as to the etiology of that singular affection which has been
described as epileptical kleptomania? The malady is, we fear, one which is

1'868.]

Notes arid News, 587

to some serious exteut epidemic, and since those who sutter Irom it appear to
be legally irresponsible as to the rights of" meum et tuum,^ it would be as well
that some steps should be taken to clear the matter up. The two " respect-
ably connected youths " who were convicted before Mr. Elliott of stealing
from the stalls in the Crystal Palace, were discharged with an admonition
only, because the testimony showed them to be aiSlicted with this very
remarkable disease. It is so much the fashion now to criticise the ** justice'fet
justice " oif the magistrates* courts, that we feel disposed to be critical as to
Mr. Elliott's procedure in the case. If these ** respectably connected **
youths were really the victims of a recognised malady, it is clear that they
deserved rather the sympathy than the censure of the bench ; but, of course,
if epileptical kleptomania be a euphemism for petty larceny, it is equally clear
that an admonition was a sentence of the most exquisitely kid-glove character.
We are anxious to see this interesting point in naental patholo^ more clearljr
defined. — Medical Times and Gazette, November 30.

A Memordndufn oh the Pay, Pbsiliofi, ah'd Edudalioh qf Assistant
Medical Officers of Asylums. By Pbofessoe Laycock, M.l).

Kb one doubts that pt^actitioners in general would be much better able tb
fulfil their duties towards the insane if they were better educated in the
'theory and practice of medicine as to mehtal diseases. With this useful
object the University of London has lately recommended this special study
to candidates for its medical de^rree, and certain medical schools have estab-
lished Lectureships of either Miedical Psycholo^ or Mental Disease, twO
'departm'ents which may be considered respectively as the theory and practice
lof mental medicine or psychiatry. From the few inquiries I have made, I
father that the attendance on these Lectureships is exceedingly small, except
m Edinburgh, and thiere, although in an exceptionally favorable position,
the attendance is also viery small compared with the number of students.
The truth is that medical students in general have no encouragement what-
ever to engage in the study, except the remote and indirect advantages it
offers.

It might bie supposed tha:t appointments to asylums as alssistant medfcal
officerls, With the prospect of promotion to be tnedical superintendentls, would
b'6 inducenieht^, but th'^y aHe not. A.bove 200 students have passed
through my own class during the last nine years, and a good proportion have
been offered such appointkhents, yet many have declined the offer.

Now, the education of the assistants mean, not only the education of the
future generation of superintendents, but also the better aid and careful of
existing superintendents. I have used the phrase " better aid and careful "
designedly, that I might hot be supposed to throw any doubt npon the zeal
and efficiency of their assistants generally, and I think, from this point of
view, we shall be all aigteed as to the value to an assistant of a special train-
ing in the theory and practice of medicinfe in mental diseases, so that we
have only to consider how that end shall be best attained. Now, since without
students lectureships will not be clarried on, it follows that students must be
induced to pursue the special study, otherwise the very means uf education
will not be forthcoming. Now, my experietice of those who have followed it
in my own class is, first, that for the most part (riofc altogether) they are first-
class men, attracted to the study for its oij^h sake ; and second, that the
position, pay, and prospects of assistant medical officers of asylums are such
that an appointment of that kind is not worth their notice, in compari^ofn

588 Noiei and New%. [Jan.,

with advantages offered to a successful career in other departments of
practice, and will lead to their retignation. The pontion. is thouffht too sub-
ordinate. 1 write this, of course, not as my theoretical opinion, but as
the experience of some of mj joung friends who have been assistants, or
have been offered appointments. Now, this drawback is much more likely
to influence the decisions of a high class of every practitioner, and I find
practically it is so. Secondly, the pay is an inadequate consideration for the
services of specially educated men. An appointment of £70 or £80 per
annum may be taken for a year or two, but this even is hardly thought
worth the skill of the class of men I refer to ; not intending to follow up the
specialty they think it a waste of time.

Then those who have accepted an appointment and desire to continue in the
career they have chosen, are disheartened and discouraged by unsuccessful
attempts at promotion to be superintendents. '* Hope Seferred maketh the
heart sick '' under any circumstances, but, with an inadequate salary, long
waiting is doubly distressing, because it is awaiting during the years when a
young man expects to be married and settled. It is obviously impossible for
all to be superintendents ; the assistant is therefore sometimes compelled to
abandon his career from sheer hopelessness as to his future prospects. I ha?e
known excellent assistants lost to the specialty in this way,wno, if their salaries
and position had been made suitable to their age and experience, would have
gladly waited on ; because in that case, although the prospects of promotion
to a full superintendency might be remote, they would have been content
with the prospective advantages of their own position.

Now, I do not see any insuperable difficulties in the way of these suggested
improvements in the position, pay, and prospects of the assistants in our
asylums. I cannot doubt that every superintendent would welcome a well-
educated assistant, and cordially concede to him such a title as ** second,'* or
"junior," or ** deputy" superintendent, provided he be of a certain age and
standing, with the respect which would belong to the title. The monev
question would be more difficult ; but the arguments in favour of a small
additional outlay are cogent. The asylum would gain in skilled services
quite equal to the increased pay ; while a most important end would be
gained, to which no money value could be attached.

It is a matter of general complaint how little our public asvlums con-
tribute to the theory and practice of medicine in that special department,
and the solid reason has been as often advanced as the complaint, namelv,
that the superintendents are overworked. Now, an educated assistant would
be able to co-operate effectively in this duty of our superintendents, to the
great advancement of mental science.

Looking, then, at the business from these practical points of view, I
venture to suggest as follows :

1. Every candidate for an assistantship in a public hospital or asylum for
the insane shall be required, after a certain date, to produce evidence that he
had attended at least one course of lectures on both the theory and
practice of medicine in mental diseases ; had attended the practice of an
asylum for three months ; and had passed successfully an oral, clinical, and
written examination. There would be no difficulty as to the latter, for
these examinations have been conducted here for some years past by
the Medical Commissioners in Lunacy for Scotland and myself.

2. That every assistant, after ( ) years' service as such, shall be entitled
to the retiring allowance and position of superintendents.

3. That the pay shall not befftn with less than ( ) per annam ; and in-
crease ( ) annually with each year of service.

4. That accommodation be provided for the wives and families of second
or junior superintendents, if they be married.

1868.] Notes and News. 589

My conviction is that some such arrangements as these would develope the
study of both theoretical and practical psychiatry in our medical schools,
would render the management of public asylums much more efficient, and
would greatly advance our knowledge of mental science.

The Honorary Secretary has to communicate the following letters : —

Thb Albany, 21f^ Nw.^ 1867.

Dbab Sib, — I beg to acknowledge the receipt of your letter of the 18th,
and shall be much obliged if you would convej to the gentlemen who have
elected me an honorary member of the Medico-Psychological Association
that 1 am much indebted to you and them for the honour thus conferred
upon me.

Believe me, dear Sir,

Always faithfully yours.

Dr. Habbiboton Tcke. W. C. Spbikg Ricb.

19, WHITEHAI.L Place, Aug, 31f/, 1867.

Deab Sir,— I beg to thank you for your letter of the 19th inst., which,
owing to my absence from London, has only just reached me.

I shall feel obliged if you will, at a fitting opportunity, acknowledge on my
behalf to the Medico-Psychological Association, my grateful appreciation of
the honour they have done me in electing me an honorary member of the
association.

I ftm, dear Sir, yours faithfully,

John D. Clbaton.

T. Habbington Tuke, Esq., M.D., Hon. Sec. of the
Medico-Psychological Association.

590 Nates and News. [Jan.^

Publications, Sfc, Received, 1867.
XConimueifrom ike * Journal of Mental Sciekee^ Oct,, 1S670

' 1^1:. George's Hospital Reports.' Edited by John W. Ojfle. M.D., F.KC.Pm
and Timothy Holines, F.R.CS. Volume II. John Churchill and Sons, itew
Burlington Street, 1867.

'Cbtts^ Hospitals: their Objects, Advantages, artd Mana^ment.* By
Edward John Waring, M.D. John Churchill and Sons, New Burlington Street,
1867 (pamphlet).

* Germinal Matter and the Contact Theory.' By James Morri^, M.D. Lond.
Second Edition. John Churchill and Sons, New Burlington Street, 1867*
pp. 111.

* The Mad Folk of Shakespeare.' Psycholoorical Essays. By John Charles
Bucknill, M.T)., F.R.S., Fellow of thfe Royaj GoHege of Physicians. Second
Edition, revised. Ldifdbn ahd Cathbrid^e : MudniiFlan and Co., 1867, pp. 333.

A beautiful rej^rint by Messrs. ^acmillan of Dr. BucknilPs charming 'Ensays on
the * Mad Folk of Sfutk'espeare.* The Essay on Ophelia is perfect. It is grati-
fying to the conductors of this Journal to say that several of these brilliant
papers originally appeared in these pages, l^he late Professor James Ferrier^ of St.
Andrews, himself a well known Shakespearean critic^ once expressed to the
writer of this note the great instruction and pleasure which he had derived from a
perusal of Br. BucknilVs "Essays ^ and 'eagerly inquired what manner of man the
author was.

'Handbook of the History of Philosophy.' By Dr. Albert Schwegler. Trans-
lated and annotated by James Hutciiison Stirling, LL.D., author of 'The
Secret of Hegel,' &c. Edinburgh : Edmonston and Douglas, 1867, pp. 417.

We hoped to have published in this number of the Journal a short review of the
excellent Handbook of Dr. Schwegler^ but pressure on our space has compelled us
to defer it till the next number.

* On State Medicine in Great Britain and Ireland.' By Henry W. Rumsey,
M.D.. F.R.C.S., &c. &c. London: William Ridgway, Piccadilly, W., 1867
{pamphlet).

This address was read, in substance^ on August 7th, 1867, at the Congress of
the British Medical Association he'd at Dublin, Several portions were then
omitted, as the time for each paper was necessarily limited. Those portions of the
paper which were read at the meeting were printed, with a report of the subsequent
discussion, in the * British Medical Journal,* of September 7, 186/.

// has seemed desirable to others, as well as to Dr. Rumsey, that the whole of
this paper should now be published in a separate form, with eorreetions, notes, and
references.

An Appendix is added, containing, in the first place, the speeches made in the
subsequent discussion, most of which have been corrected by the respective speckers,
with the resolutions adopted by the association ; and, secondly, some remarks made

1868.] Notes and News. 591

by Dr. Rumsey during the last session of the General Medical Council, on that pari
of this question which affects medical education.

This pamphlet, therefore, contains the most complete and recent exposition of
Dr. Rumsey's views on State Medicine : that branch of medical science which he,
as it were, brought from its continental home, and acclimatised in England by aid
of his eloquent teaching. ■■.....

* Ueber Erkrankungen des Ruckenmarks bei der allgemeiaen progressiveiL
Paralyse der Irren.' Von Dr. C. Westphal, in Berlin. Mit einer. Tafel.
(Separatabdruck aus * Virchow's Arcliiv fiir Pathologische Anatomie und Phy-
siologie uud fiir Kiinische Medicin/ Neununddreissigster Band.)

'Die Patiiologischen Gewebsverandernngen des Ohrknorpels und deren
Beziehungen zur Olirblutgescliwulst.' Von Dr. Ludwig Meyer in Hamburg
(a reprint).

* Remarks on the Luna^ Acts , for Scotland and District Pauper Lunatic
Asylums.* By A. Watson Wemyss, M.D., Fellow of the Royal College of Bur-
geons of Ed i burgh, formerly one of the Surgeons and Clinical Lecturer of the
Royal Infirmary of Edinburgh, &c. &c. ; author of 'A Medico-Legal Treatise on
Homicide by External Violence/ &c. &c. Edinburgh : Maclachlan and Stewart,
South Bridge Street, 186i[ (pamphlet).

* Das Asyl mit seinen beiden Gartenbau-Colonieen fiir Geraiiths- und Ner-
venkranken zu Bendorf bei Coblfiiz.' Von Saniiatsrath Dr. A. Erlenmeyer.
Neuwied 1867. Striider*sche Verlagsbuclihandlung (pamphlet).

* Bendorf-Sayn. Asyl fiir Gehlrn- uud Nervenkranke unter Direction des
Dr. C. M. Brosius. Berlin : bei August Hirschwald, 1867 (pamphlet).

'Insanity in its Medico-Legal Relations. Opinion relative to the Testa-
mentary Capacity of the late Jilnes C. Jbhnitbn, of Chowau County', North
Carolina.* By Wm. A. HHmmond, M.D., &c. New York : Baker, Voorkish and
Co., 66, Nassau Street, 1866 (pamphlet).

'Report of the Proceedings of the Association of Medical Superintendents of
American Institutions fur the Insane.' 1867 (pamphlet).

Appointments.

W. J)axon, M.p., has been appointed Resident Medical Superintendent of the
New District Lunatic Asylum at Ennis.

T.W. Shiell, M.B., Resident Medical Superintendent of the Lunatic Asylum,
Maryborough, has been appointed Resident Medical Superintendent of the New
Lunatic Asylum at Enniscorthy, Co. We:^ord^ .

G. St. G. Tyner, L.K.Q.C.P.I., has been appointed Resident Medical Super-
intendent of the Auxiliary Lunatic Asylum, Clonmel.

Y, W. A. Skae, M.D., has been appointed Medical Superintendent of the
Stirling, ^c, District Lunatic Asylum.

J. R. M'Clintock, M.D., &c., late Assistant-Physician, Royal Asylum, Perth,
has been appointed Physician to the Strettou Home and Grove Private Asylums^
Church Stretton, Shropshire.

592 Notes and News. [Jan.^

A. R. Gray, M.D. (recently Assistant to Dr. Jamieson, Royal Lnnatic Asy-
lum, Aberdeen), has been appointed Resident Medical Officer of the Banffshire
Lunatic Asylum.

G. M. Bacon, M.D., has been appointed Resident Medical Superintendent of
the Cambridgeshire, Isle of £ly, and Borough of Cambridge Lunatic Asylum at
Eulbourn, near Cambridge, vice G. W. Lawrence, M.I>. Lond., who retires
upon an annuity by way of superannuation.

A. J. Newman, M.R.C.S.E., has been appointed Assistant Medical Officer at
the Criminal Lunatic Asylum, Broadmoor, Wokingham, vice Francis W. Gibson,
M.D., appointed Medical Officer to the St. Pancras Union Infirmary.

Dr. Rearder has been appointed Medical Superintendent of the Carmarthen
and Joint Counties Lunatic Asylum.

R. W. Keogney, M.D., has been appointed Assistant -Physician at the Pro-
vincial Hospital for the Insane, Halifax, Nova Scotia.

T. J. Colman, M.R.C.S.E., has been appointed Assistant-Physician to the
Royal Asylum for the Insane, EdinburgL

J. Rutherford, M.D. Edin., has been appointed Assistant Medical Officer to
Birmingham Borough Lunatic Asylum.

Obituary.

On the 37th October, at Chelmsford Terrace, Bayswater, in his 76th year,
John Mills Probyn, Esq., M.D., M.R.C.S., late of Newbury, Berks, and formerly
Superintendent of the Royal Glasgow Asylum and the County Lunatic Asylum,
Lancaster.

Errata.

In the address by Dr. Mundy on the '*Lanacy Laws in Europe," published in
our last number, the following errors occur : —

' At page 821, Une l3, the passage beginning " There is a rule," &c, should read
thus : — ** There are also cases when obligatory certificates are required to be ngned
merely as it were for disciplinary reasons, although such proceeding is not sanc-
tioned by the law of 1838."

At page 832, the statements that the Norwegian Insane Act was passed in 1838»
and the Swedish Act in 1845, should be respectively 1848 and 1868.

At page 824,'instead of 600,000 read 500,000, and instead of 850,000 read
50,000.

1868.J Notes and New9^ 59S

Notice to Correspondents.

English books for review, pamphlets^ exchange journals, &c.| to be sent either
by book-post to Dr. Robertson, Hayward's Heath, Sussex:; or to the care of
the publishers of the Journal, Messrs. Churchill and Sons, New Burlington
Street. French, German, and American publications may be forwarded to
Dr. Eobertson, by foreign book-post, or to Messrs. Williams and Norgate»
Henrietta Street, Covent Garden, to the care of their German, French, and
American agents, Mr. Hartmann, Leipzig; M. Borrari, 9, E.ue de St. Peres«
Paris ; Messrs. Westermann and Co., Brtuidway, New York.

Authors of Original Papers wishing Reprints for private circulation can have
them on application to the Printer of the Journal, Mr. Adlard, Bartholomew
Close, E.C., at a fixed charge of 30«. per sheet per 100 copies, including a
coloured wrapper and title-page.

The copies of Tke Journal of Mental Science are regularly sent hy Book-post
(prepaid,) to the ordinary Members of the Association, and to our Home and
Foreign Correspondents ; and Dr. Robertson will be glad to be informed of any
irregularity in their receipt or overcharge in the Postage.

The following EXCHANGE JOURNALS have been regularly received since
our last publication :

The Annates Medico-Psyckoloffiques ; the Zeitschrift fur Fsyckiatrie; the
Vierteljahrsschrift fur Psychiatric in ihren Beziehungen zur Morphologic und
Pathologic dcs Ocntral^Ncrvensystcms^ der physiologischen Psychologies Slatistik
und gerichtlichen Medicin, herausgegeben von Professor Dr, Max Leidesdorf und
Docent Dr, Theodor Meynert ; Archiv fur Psychiatric und Nervenkran&hetten, in
Ferbindung mit Dr, L, Meyer und Dr, C, Westphal, herausgegeben von Dr, W,
Griesinger ; the Correspondem Blatt der deutschen Gesellschtfl fur Psychiatric ;
Archiv fur Psychiatric; the Irren Freut^d; Journal de Medecine Mcntale f
Archivio Italiano per le Malattie Nervose c per le Alienazioni Mentali; Mcdi^
zinische JahrbUcher {Zeitschrift der K, K, Gesellschaft der Aerzte in Wien) ; the
Edinburgh Medical Journal ; the American Journal of Insanity; the Quarterly
Journal of Psychological Medicine^ and Medical Jurisprudence^ edited by William
A. Hammond^ M.D. {New York) ; the British and Foreign Mcdico-Chirurgical
Review ; the Journal of Anatomy and Physiology, conducted by G. M. Humphrey^
M.D. F.R.S., and JFm. Turner, M.S., F.R.S.E. ; the Dublin Quarterly Journal;
the Medical Mirror; the British Medical Journal; the Medical Circular; and
the Journal of the Society of Arts. Also the Momingside Mirror; the Fork
Star; Excelsior^ or the Murray Royal Institution Literary Gazette,

On and after the 1st of October great facilities are given for the transmission
of periodicals between England and the United States of America, by Book Post*
We trust our American Correspondents will avail themselves of them.

Note to Dr. S. W. D. Williams' paper " A few Words in answer to Dr.
Edgar Sheppard,**

With reference to an extract from the British Medical Journal (Nov. 30)*

594 Notes and News, [Jan., 1868.

which I find as a foot-note in my reply to Dr. Edgar Sheppard, T think it fair
to reprint, here ihe following letter, which appears iu the same journal of to-day
with reference to that paraj,^raph. * S. W. D. W.

Hay ward's Heath ; December 28.

THE COLNEY HATCH LUNATIC ASYLUM.

Siu, — I am very sorry that your first notice of Professor Griesinger*s " new
and excellent journal'' bhouid be the embodiment of a perfectly false statement.
Tlie article to which you refer in last week's number of the British Medical
Journal^ was written by Dr. Carl Westphnl, the as||stant of Professor Grie-
singer in Berlin; and this gentleman L had the honour (^/V) of conducting
round the Asylum in July last. I now beg leave to give the most distinct denial
to Dr. Westphal's statement, that manaical, or indeed any other classes of
patients ** were shut up in cells perfectly naked." The greatest care is takeu
nere that the patients are perfectly and efficiently clothed; and the attendants
have most rigorous instructions to that effect. I have a distinct recollection of
Dr. Westphal's visit, and can affirm most certainly that none of his statements
are correct.

With reference to *' the discussion of the impropriety of such a procedure"
(apart from Dr. Westphal's manner of criticising the treatment pursued in an
asylum shown him at the requ-st of the personal friend of the superintendent),
I remember none such ; but I do remember that Dr. Carl Westphal was particu-
larly anxious to enforce some ideas of his own on lesions of the spinal cord in
general paralysis. Most probai>ly, the great interest he takes in his own
observations causes him to mistake one's courtesy in listening to what a
foreigner has to say for ac(juiescence in the subject. At whatever Gamaliel's feet
1 miuht be inclined to sit, certainly at Dr. Westphal's I bhall not be found ;
and I beg to put iu a distinct disclaimer to any participation in his views or
arguments.

The Commissioners in Lunacy at their recent visit expressed themselves
highly satisfied with the manner in which the patients were treated ; but per-
haf>s Dr. Carl Westphal sets himself up for their critic.

The paper referred to rests entirely on questions of fact ; and Dr. Westphal's
statements of tliese facts is absolutely and entirely false. As the power of
contradicting these statements rests, with none so perfectlv as with myself, I
have judged it right to set the truth clearly forward. I am, etc.,

T. Clayis Shaw, B.A., M.D. Lond.,
Attiilant Medical Officer^ Middlesex County
Lunatic Asylum, Colney Hatch.
Colney Hatch, December 4th, 1867.

*«* JTe have appealed in vain to Dr. Claye Shaw to modify the language of the
above letter ; and we now insert it, notwithstanding that the language of the
writer in this, and in another communication relating to it, is such as would pro^
perlg exclude it from publication, because the interests and reputation of his senior
officer. Dr. Sheppard, and of the asylum^ might be prejudiced if the discourtesy of
the writer were to prevent the statement which he makes from being placed be/ore
our readers. — British Medical Journal, December 28,

INDEX TO VOL. XIII.

l.-ORIQINAL ARTICLES.

Acute mania and acute maniacal delirium, Dr. H. Maudsley on, 59
Alton Murder, the, 548

Aphasia, or loss of speech in cerebral disease. Dr. F. Bateman on, 521
Asylums for the Insane, Irish district, 556

in St. Petersburg and Copenhagen, Dr. T. B. Belgrave
on, 7

Bateman, Dr. F., on aphasia, or loss of speech in cerebral disease, 521
Belgrave, Dr. T. B., on the asylums for the insane in St. Petersburg and Copen-
hagen, 7
Bordier, Louis, the sanity of, 532

Christie, Dr. T. B., on the treatment of a certain class of destructiye patients at

Colney Hatch Asylum, 608
Civilization in Southern Italy, 560
Clinical cases, 59,^176, 497

Davey, Dr. Ji G., on the insane poor in Middlesex and the Asylums of Hanwell

and Colney Hatch, 314
Davies, Bev. W. G., on the extension of the organism in three dimensions, 825
Destructive patients, treatment of a certain class of, at Colney Hatch Asylum,

„ „ Dr. T. B. Christie on, 608

„ „ Dr. E. Sheppard on, 65, 834

„ „ Dr. 8. W. D. Williams on, 176, 510

Dunn, Mr. B., on the phenomena of life andmind, 4^37

Extension of the organism in three dimensions, Bev. W. G. Davies on, 825

Gabites. Henry, the case of, Dr. J. Kitching on, 141
Gasquet, Mr. J. B., on progressive locomotor ataxia, 158
Gheel, a visit to. Dr. E. Neuschler, 20
Gibson, Dr. F. W., on the thermometer in nervous diseases, 497

Insane negroes in the United States, 552

„ poor, the care and treatment of, Dr, C. L. Robertson on, 289
„ „ „ „ with special reference to the insane in

private dwellings, Dr. A. Mitchell
on, 472
„ „ in Middlesex and the Asylums at Hanwell and Colney Hatch, Dr. J.
G. Davey on, 314
Italy, Southern, civilisation in, 550

596 INDEX.

Eitching, Dr J., on the case of Henry Gabites, 141

Life and mind, observations on the phenomena of, by Mr. B. Dunn, 437
Lunacy, a comparative examination of the laws of, in Europe, by Baron J.
Mundy, 319
the state of, in Great Britain and Ireland, in 1866, Dr. C. L. Robertson
on, 449
Lunatics of Scotland, criminal, Mr. J. B. Thomson on, 1

Matron of the Carmarthen Asylum, the, 664

Maudsley, Dr. H., observations on recent contributions to the pathology of

nervous diseases, 44
on acute mania and acute maniacal delirium, 59
Medico-legal study, on the case of Henry Gabites, Dr. J. Kitching, 141
Mitchell, Dr. A., on the care and treatment of the insane poor, with special

reference to the insane in private dwellings, 472
Monomania, and its relation to the civil and criminal law. Dr. H. Tuke on,

306
Mundy, Baron J., on a comparative examination of the laws of lunacy in Europe,
819

an introductory lecture on psychiatry by, 168
Murder, the Alton 548

Xerve-force, the velocity of, 331

Nervous diseases, the pathology of. Dr. H. Maudsley on, 44

the value of the thermometer in. Dr. F. W. Gibson, on, 497
Neuschler, Dr. E., on a visit to Gheel, translated, with remarks, by Dr. J. Sibbald,

20
Non-restraint system in the treatment of a certain class of destructive patients,

Dr. S. W. D. Williams on, 176

Pathology of nervous diseases, observations on recent contributions to the, by

Dr. H. Maudsley, 44
Phenomena of life and mind, observations on the, by Mr. B. Dunn, 437
Progressive locomotor ataxia, Mr. J. R. Gasquet on, 158
Psychiatry, introductory lecture on, by Baron J. Mundy, 168
Psychological intuition, 553

Robertson, Dr. C. L., on the care and treatment of the insane poor, 289

on the state of lunacy in Great Britain and Ireland in 1866,
449

Sanity of Louis Bordier, 632

Sheppard, Dr. E., on the treatment of a certain class of destructive patients, 65,

334
Sibbald, Dr. J., a translation of Dr. E. Neuschler's visit to Gheel, 20

Thermometer, value of, in nervous diseases. Dr. F. W. Gibson on, 497

Thomson, Mr. J. B., on the criminal lunatics of Scotland, 1

Tuke, Dr. H., on Monomania, and its relation to civil and criminal laws, 806

Williams, Dr. S. W. D., a few words in answer to Dr. E. Sheppard, 610

on the non- restraint system in the tr^tment of a certain
class of destructive patients, 176

United States, insane negroes in, 552

INDEX. 597

1 1. -REVIEWS.

Clinical Medicine, Lectures on, at the Hotel Dieu, Paris (Professor Trousseaa},

translated and edited by Dr. P. V. Bazire, 197
De la 1^'olie raisonnante et de I'importance du delire des Actes pour le diagnostio

et la mddecine l^ale (M. Brierre de Boismont), 341

Excerpta from the English County and Borough Asylum Reports, 363

Abergaveny (Joint Counties) Asylum, 373

Buckinghamshire County Asylum, 365

Cambridge County Asylum, 366

Carmarthen (Joint Counties) Asylum, 367

Cheshire County Asylum, 367

Cumberland and Westmorland Counties Asylum, 368

Denby (North Wales Counties) Asylum, 369

Devonshire County Asylum, 369

Dorset County Asylums, 361

Durham County Asylum, 362

Essex County Asylum, 363

Glamorgan County Asylum, 364

Gloucester County Asylum, 366

Hampshire County Asylum, 366 ^

Lancashire County Asylum (Lancaster), 366
„ „ „ (Prestwich), 367

„ „ „ (Rainhill), 368

Leicester and Rutland Counties Asylum, 368

Lincoln County Asylum, 368

Middlesex County Asylum (Colney Hatch), 369
„ „ „ (Hanwell), 371

Northampton General Lunatic Asylum, 374

Oxford and Berkshire Counties Asylum, 376

Shropshire and Montgomery Coimties Aisylum, 375

Somerset Coimty Asylum, 376

Suffolk County Asylum, 378

Sussex County Asylum, 378
Idiocy, and its treatment by the physiological method (Dr. Edward Seguin), 188
Liaugural Address to the University of St. Andrew's (J. S. Mill, M.P.), 848

Mental pathology and therapeutics (Professor Griesinger) ; translated by Drs. L.
Robertson and J. Rutherford, 76, 208

Modem Culture — its true aims and requirements: a series of addresses and argu-
ments, edited by Dr. E. L. Toumans, 86

St. George's Hospital Reports, Vol L for 1866, 217

lll.-REPORTS ON THE PROGRESS OF PSYCHOLOGICAL MEDICINE.

Ancient British Skulls, two types of. Dr. J. Thumam on, 127
Annales M^dico-psychologiques, Vols. VII. and VIII. for 1866, 568

Medico-legal inquiries relative to insanity, by M. Dagonet, 574

,) report on the case of a man accused of theft, by M. AdilUe
Foville, 667
on the case of Mollard, by Dr. H. Bonnet, 576

on the case of Louis F , by M3I. Bourqaetand

V. Combes, 676
), on the case of Seiler, by M. Dagonet, 675

on the mental condition of Jacques Band, by M. V.
Combes, 677

598 INDEX.

Nervous System, and the connection between mind and body, M. Otton,

664
Passion, Immorality, and Insanity, M. Tissot on, 573
Paralytic Dementia in Cuba, Dr. Munoz on, 574
Utility of family life in the treament of the insane, Dr. Brierre de Bois-

mont on, 670
Archivio Italiano per le Malattie Nervose e per le Alienazioni, for 1866, 219

Bromide of Potassium and Bromide of Quinine in nervous diseases, Dr.

Liberali on, 230.
Calcareous concretions, the development of within the cranial cavity,

Dr. Giulio Bizzozero on, 226
Lunacy reform, Dr. Castiglioni on, 223
Melancholia terminated by erysipelas, 224
Mental disorders, their classification and treatment by coca (Erythroxy-

lon coca). Professor Mantegazza on, 232
Neurosis, lingular case of. Dr. C. Berarducci on, 225
Old and new Asylums of St. Nicholas of Sienna, Dr. C. Livi on, 231
Phrenic nerve, the anatomy and physiology of. Professor Panizza on,

223
Pseudochromestesia, or false sensation of colour. Dr. Berti on, 223.
Wife-Murder, report on, by Drs. Tachini, Bonfanti, and Tuffi, 228.

Corpus oallosum, case in which it was defective. Dr. J. L. H. Down on, 119

English Psychological Literature, report on, by Dr. S. W. D. Williams, 114
Ethnic classification of Idiots, Dr. J. L. H. Down on, 121

French Psychological Literature, report on, by Dr. J. Sibbald, 563

German „ „ by Dr. J. Sibbald, 88, 236

Insanity and the criminal responsibility of the Insane, Dr. T. M. Madden on,

126
Italian Psychological Literature, report on by. Dr. J. T. Arlidge, 219

Lectures on Insanity, delivered at St (George's Hospital, by Dr. G. F. Blandford,
114

Marriages of consanguinity in relation to degeneration of race, Dr. J. L. H.
Down on, 120

Peculiar delirium after fever. Dr. H. Jones on a case of, 123

ZeitBchrift fiir Psychiatric, Vols, XXI. and XXH., 88

Cold bathing as a remedy in mental disease, Professor Albers on, 96
„ „ Dr. Finkelnburg on, 100

Cretaceous tumours in the insane, Dr. Pipping on, 112
Development of grey matter in the walls of the lateral ventricles,

Dr. Meschede on, 105
Diminished responsibility. Dr. Fleming on, 108
Echinococci in the brain producing mental derangement, Dr. J,

Knock on, 102
Gheel, results of treatment at, Dr. F. Wiedemeister on, 92
Halle A£ylum, statistics of. Dr. Damerow on, 112
Hereditary tendency in insanity, Dr. W. Jung on, 106, 252
Hydrocephalus and insanity, F1x)feBsor Albers on, 112
Intermittent fever, its influence on insanity. Dr. W. Nasae on, 88
Measurement of the cranium, Dr. F. Obemier on, 108
Melancholia, treated with opium, Dr. Twigges on, 108

INDEX. 599

Memory, its retention in different forms of insanity, Dr. 0. Pelman

on, 91
Morbid conditions of the mind, Dr. Wille on. 92
Prejudice against the insane. Professor Jessen on, 113
Pupils, an instrument for determining differences in the size of the.

Dr. F. Obemier on, 105
Tabes dorsalis, and paralysis imiversalis progressiva, Dr. Westphal

on, 102
T3rphu8 amongst the insane, Dr. Wille on, 107
Zeitschrift fur Psychiatric, Vol. XXIU., 236

Adhesion of the pia mater, Dr. L. Besser on, 252

Clinical diagnosis between dementia paralytica and other cerebral

diseases, Dr. v. Krafft-Ebng on, 240
Delusions of the senses, Dr. Kahlbaum on, 235
Dementia paralytica, its history and literature, Dr. ▼. Erafft-Ebng

on, 253
Hereditary influence in insanity. Dr. Jung on, 252
Mania acutissima, occurring during a paroxysm of intermittent fever.

Professor Erhart on, 238
Mental freedom, a principle in forensic psychology. Dr. Wiebeoke on,

252
Pneumonia and mental derangement, Dr. Wille on, 252

IV.-PSYCHOLOQICAL NEWS.

Appointments, 139, 284, 434, 591

Assistant medical officers of asylums, their pay, position and education, Pro-
fessor Lay cock on, 587
Asylum cottage at the Paris Exhibition, 425

„ the Colney Hatch, 594

„ unlicensed at Aldringham, 426
Asylums, Pavilion, 282

Bill, Metropolitan Poor, 133

Bust of the late Dr. GonoUy presented to the Boyal College of Physicians, 264

Chancery Lunatic, a, 269

Emanuel Swedemborg, 273
Empress Charlotte, the, 283
Epileptic kleptoniania, 686

Gheel question. Dr. Eitching on, 131

Hell, modem (Bomish) ideas of, 280

Insane poor, care and treatment of, 585

Eitching, Dr., on the Gheel question, 131
Kleptomania, epileptic, 386

Lawrence, Wm., F.R.S. (obituary), 434

Laycock, Professor, on the pay, position and education of the assistant medical

officers of asylums, 587
L'Empereur d'Autriche chcz le Baron Mundy, 686
Light, Dr. Forbes Winslow on, 278
Lunacy Commissioners, and the Surgical Home for Women, 129

600 INDEX.

Lunacy prosecutions, 578, 680

Lunatic, a Chancery, 268

Lunatics, the supervision of, in private dwellings, 135

Luther, was he mad ? 260

Maudsley, Dr. H., on the physiology and pathology of the mind, 255

Medico-Psychological Association, annual meeting of, 137, 380

„ „ letters to Honorary Secretary of, 689

., Society of Paris, extraordinary meetings of, 2S5, 422

Mental Philosophy, recent contributions to, 262

Metropolitan Poor Bill, 133

Modem (Romish) ideas of hell, 281

Kotioes to correspondents, 140, 285, 435, 593
Obituary, 140, 434, 592

Paris Exhibition, the asylum cottage at the, 425

„ Medico- Psychological Society, extraordinary meetings of, 285, 422
Pavilion asylums, 282

Physiology and pathology of the mind. Dr. H. Maudsley on, 255
Probyn, Dr. J. M. (Obituary), 592
Private dwellings, the supervision of lunatics in, 135
Publications received, 137, 283, 433, 590

Shaw, Dr. Claye, a letter on the Colney Hatch Asylum, 594

Dr. E. 6. J., prosecution of, 578, 580
Statistios of suicide, 433
StUwell, Dr. G. J. (Obituary), 436

Surgical home for women, and the Lunacy Commissioners, 129
Sutherland, Dr. A. J. (Obituary), 140
Swedenborg, Emanuel, 273

Unlicensed Asylum at Aldringham, 426

Window, Dr. Forbes, on light, 278

I%e Editors a/re indebted to Dr. Deem Fm/rless^ of SUlgarden HousCf QmjMur'
Angus f Perthjfor the compilaMon of this Index,

Pulvis Jacobi Yer., Newbery's.

FRANCIS NEWBERT AND SONS,
45, St Paul's ChTircliyaTd.

Second Edition, 8vo, cloth, 15s.

A MANUAL OF PSYCHOLOGICAL MEDICINE;

containing the History, Nosology, Description, Statistics, Diagnosis, Pathologyi
and Treatment of Insanity. With an Appendix of Cases. By J. C. BUCK-
NILL, M.D., F.R.S., and DANIEL H. TUKE, M.D.
"The most comprehensive and practical English work upon insanity now
extant." — Medico- Chirurgical lUview.

JOHN CHUECHILL AND SONS, New Bublington Street.

8vo, Is.

ON THE EFFICACT of the BROMIDE of POTASSIUM

m EPILEPSY and CERTAIN PSYCHICAL AFFECTIONS (see Reynolds'
System of Medicine, Vol. II., p. 258, 281.) By S. W. D. WILLIAMS, M.D.

JOHN CHURCHILL AND SONS, New Bublington Street.

Just published, 8yo, Is.

CLASSIFICATION OF THE FUNCTIONS OF THE

HUMAN BODY, and the Principles on which it Bests. By ANDREW
BUCHANAN, M.D., Professor of Physiology in the University of Glasgow.

JOHN CHURCHILL AND SONS, New Bublington Stbbbt.

8vo, cloth, 8s.

LECTURES ON MENTAL DISEASES. By W. H. 0.

SANKEY, M.D., Lond., F.B.C.P., Lecturer on Mental Diseases in Universify

College, London.
" The Lectures on ' General Paresis * and on the * Pathology of Insanity ' are
valuable and original contributions to the study of Mental D&ase."— J^mriioZ qf
Mental Science,

JOHN CHURCHILL AND SONS, New Burlington Street.
Seventh Edition, with Engravings, 12mo., cloth, 5s.

A COMPENDIUM OF DOMESTIC MEDICINE, AND

COMPANION TO THE MEDICINE-CHEST ; comprising Plain Directions
for Emplojrment of Medicines, their Properties and Doses — Brief Descriptions
of the Symptoms and Treatment of Diseases, including Disorders incidental to
Infants and Children — Directions for Restoring Suspended Animation and
Counteracting the Effects of Poison ; also a selection of the most efficadoua
Prescriptions, and various Mechanical Auxiliaries to Medicine. To which is
added an Appendix on Cod-liver Oil, its Purity, Mode of Pteparation, and
Administration. The whole intended as a source of easy Reference tor
Clerg3rmen, Master Mariners, and Travellers, and for Families Resident at a
Distance from Professional Assistance. By JOHN SAVORY, Member of the
Society of Apothecaries, London.

JOHN CHURCHILL AND SONS, New Burlington Street.

This Day, in 8yo, oloth, price 258.
THE SECOND VOLUME OF

DR. REYNOLDS' SYSTEM OF MEDICINE

CONTENTS.

I.— Diseases of the Nervous System.

Innnt^. By Dr. Mauduet.

AkohoHim. By. Dr. Aifsni.

Ecstacy, Somnambalism, Catalepsy. By Dr. T.

K. GUAMBGiW.

Chorea, Locomotor Ataxy. By Dr. C B. Rad-

CLirrs.
Vertigo. By. Dr. Uammkill.
Snnttroke. By Dr. Maclran.
Wasting Palsy. By Dr. W. Koberti.
Paralysis Agitans, Metallic Tremor. By Dr. W.

R. Sandeiu.
Gonvuldona. By Dr. II. Jackson.
Epilepsy, Hysteria, Writer's Cramp, Mnscnlar

Ananthe^ii. Hy Dr. J. K Ketnolos.
Hypochondriasis. By Dr. Ol'ix and Dr. Anstis.

II.— Partial Diseases of tiie Nervous

System.

A.— DISEASES OF THE HEAD.

Simple Meningitis and (.'hronic Hydrocephalus,
Meningeal IlaMnurrhage, Tumour of the
Meninges* Hacmutoma. By Dr. Kamskilu

Tubercular Meningitis. By Dr. S. J. Gee.

Congt-stton of the Brain, Cercbritis, Softening
of the Brain, Adventitious I^roducts in the
brain. By Dr. J. R. Reynolds and Dr.

BASnAM.

Apoplexy and Cerebral Haemorrhage. By Dr.
HuoHLUfos Jackson.

Abscess of the Brain. By Dr. Qxtll and Dr.

SUTTOSf.

B.— DISEASES OF THE SPINAL CORD.

Ifeningitis, Myelitis, Congestion, Tetanus, Spinal
Irritation, General Spinal Paralysis, Keflex
Paraplegia. Hystericsd Paraplegia, Infantile
l*aralysis. Spinal HsemOrrhage, Non inflam-
matory Spinal Softening, Induration, Atrophy ,
II>'pertrophy, Tumour, Concussion, Compres-
sion, Caries of the Column, Spina Bifida. By
Dr. C. B. Kadcliffb.

Epidemic Cerebru-Spinal Meningitis. By John
Nettem Kadcuffe.

C— DISEASES OF THE NERVES.

Neuritis, Neuroma, Local Spasms, Local Para-
lysis, Local AnsBsthesia. By Dr. J. W.
Beubie.

Neuralgia. By Dr. Anstie.

Torticollis. By Dr. J. R. Reynolds.

Diseases of the Digestive System.

I.— DISEASES OF THE STOM\CH.

Disorders of Function, Atonic Dyspepsia,
Neuroses, Gastritis (Acito and Chronic),
Ulcer, Cancer, Haemorrhage, Hypertrophy,
Stricture, Obstruction, Dilatation, Softening,
Perforation, Rupture, Tubercle. By Dr.
Wilson Fox.

Volume I., containing "General Diseases," 8vo., cloth, price 25s.

THE PHYSIOLOGY AND PATHOLOGY OF THE

MIND,

By HENRY MAUDSLEY, M.D. Lond., Physician to the West London Hospital,
&c. 8vo, cloth. New and Revised Edition in the press.

" It is long since we read a scientific work of any kind, of which the raison d'etre
was so thoroughly good and important, or which accomplished so much towards the
fulfilment of a most arduous and laborious task.'* — The Lancet.

** Dr. Maudsley has had the courage to undertake, and the skill to execute, what
is at least in English an original enterprise. His book is a manual of mental
science in all its parts, embracing all that is known in the existing state of physio-
logy."— Saturday Jievierv.

** We lay down the book with admiration, and we commend it, most earnestly,
to our readers, as a work of extraordinary merit and originality ; one of those pro-
ductions that are evolved only occasionally in the lapse of years, and that serve to
mark actual and very decided advances in knowledge and science." — New York
Hedioal Journal,

" It is a work of great power, and we anticipate for it a wide influence." — North
Americwi Review,

MACMILLAN AND CO.. London.

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